He has inguinal hernia. Should he go to the ER again?
84 y.o. with inguinal hernia on left; it was reduced by pushing it back in two days ago when admitted to ER. PMH includes liver cirrhosis, COPD, inguinal hernia surgery. Two days later (after discharge) he has abdominal bloating, no bowel movement, low urine output, and insomnia; he changes position (b/t lying on back and sitting) due to discomfort.
Inguinal Hernias are very common with age. They can be direct (protrudes direct through the abdominal wall) or indirect which protrudes through the inguinal canal. There are a few dangerous signs that needs immediately attention. If the hernia is protruding but if it can easily be pushed back in and it is not causing pain, a visit to the primary care doctor or to the surgeon's office that fixed the hernia is appropriate. Now, this gentleman that your are describing seems be in considerable distress. He has to sit in one position due to pain. This is a huge red flag and should prompt immediate ER presentation. If there is pain on any way, or if the area is red and inflamed this can be signs that the hernia is becoming incarcerated. That means that a loop of bowel is stuck in the opening and the blood supply to the area is quickly becoming compromised. This can lead to bowel necrosis and or perforation which will require major surgery to correct and can lead to death. The risks can be even greater for people with comorbidities as is the case of this man with cirrhosis. Thus, if he is having discomfort, immediately bring him to the emergency room to have it evaluated and promptly corrected.
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