A two-month old infant presents to the emergency department with irritability and nonbilious emesis. There is a tender mass in the right inguinal region which is not able to be reduced. Which of the following findings is a contraindication to attempting nonoperative reduction?

 

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[size=20px]A dilated loops of bowel on an abdominal radiograph

 

B temperature of 38.9° C

 

C erythema of the inguinal region

 

D ultrasound demonstrating no flow to the bowel in the hernia

 

E rebound abdominal tenderness[/size]

C erythema of the inguinal region

D ultrasound demonstrating no flow to the bowel in the hernia

think again my friend

think again my friend

A dilated loops of bowel on an abdominal radiograph

Think again my dear

B temperature of 38.9° C

The answer is:

E rebound abdominal tenderness

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I do not agree that rebound abdominal tenderness is the right answer. Erythfma with inability to reduce with dilated loop on Xray are also factors to be considered.

I do not agree that rebound abdominal tenderness is the right answer. Erythfma with inability to reduce with dilated loop on Xray are also factors to be considered.

sure prof, Erythema with inability to reduce with dilated loop on X-ray are important (but a relative contraindication to attempt reduction), I think rebound abdominal tenderness as an indication of peritonitis is an absolute contraindication to reduce an irreducible hernia.

Rebound tenderness is difficult to illicit in small children and is unreliable. THis is my experience

I have learned from my professor good clinical advice in babies with a strangulated hernia

first to not rush to reduce the hernia before sedating the baby

once the child is asleep hold the hernia firmly and do not let go if the baby cries. If you manage to reduce the hernia it is never gangrenous

You can never reduce gangrenous bowel

this is from 46 years experience