A 75-year-old man with a right inguinal hernia presents to the emergency department with an irreducible, tender, non-transilluminable scrotal swelling for 8 hours. Abdominal X-ray shows no dilated bowel. What is the most important immediate management decision?

• A Taxis (manual reduction) followed by elective repair in 48 hours
• B IV antibiotics and IV fluids and observation for 24 hours
• C Urgent surgical exploration regardless of viability assessment ✓
• D CT scan with contrast to characterize hernia contents before any intervention

Explanation

An irreducible, painful inguinal hernia presenting for 8 hours with scrotal involvement represents a strangulated hernia until proven otherwise — this is a surgical emergency. Strangulation causes bowel ischemia within 4–6 hours of vascular occlusion. Urgent exploration is mandatory because viability can only be definitively determined intraoperatively. Manual taxis may reduce strangulated bowel into the abdomen masking necrosis and is contraindicated. Antibiotics and observation delay life-saving surgery. CT may delay operating in an already-identified emergency — clinical diagnosis suffices for urgent surgical decision-making.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.