A 60-year-old man with a long-standing reducible inguinal hernia presents after 12 hours of irreducibility. Compared with his usual symptoms, he now has severe constant local pain and marked tenderness over the hernia itself. Which additional single finding on examination of the hernia best supports strangulation rather than simple obstruction?

• A A gurgling sound on attempting reduction
• B Presence of visible peristalsis over the swelling
• C Increase in size of the swelling when standing
• D Absence of a cough impulse over the hernia ✓

Explanation

Loss of the cough impulse indicates the hernial contents are no longer freely communicating with the peritoneal cavity because the neck is constricted, a hallmark of strangulation together with tenseness, tenderness and loss of translucency. Visible peristalsis suggests obstruction but occurs with simple obstruction as well. Gurgling on attempted reduction suggests the hernia is still reducible. Severe local pain plus an absent cough impulse in a previously reducible hernia demands emergency exploration.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.