A man presents within hours of noticing his long-standing reducible inguinal hernia has become irreducible and painful, but he has no vomiting, no distension, no tenderness over the lump, and no skin changes. Attempted manual reduction (taxis) is being considered. In which situation is taxis absolutely contraindicated?

• A The hernia has been irreducible for less than 6 hours with no signs of obstruction
• B The patient is elderly with significant cardiopulmonary comorbidity
• C The hernia has been irreducible intermittently for several months
• D There is tenderness, erythema of overlying skin, or features of intestinal obstruction ✓

Explanation

Taxis is contraindicated whenever strangulation is suspected: tenderness over the sac, erythema, or signs of intestinal obstruction indicate compromised bowel, and forceful reduction risks reducing a gangrenous segment en masse into the peritoneal cavity, producing perforation and peritonitis. It is also avoided in recent-onset irreducibility with uncertain status and in infants. Early uncomplicated irreducibility without obstructive or inflammatory signs may be reduced gently by an experienced clinician, though operative repair remains definitive.

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.