Point-of-Care Ultrasonography for Hernia Reduction: A Case of Incarcerated Umbilical Hernia.

BACKGROUND:Manual reduction of an incarcerated hernia is used to avoid emergency surgery, which comes with risks of complications and death, especially in patients with severe comorbidities. However, there are no established procedures for hernia reduction.CASE REPORT:We present the case of an 82-year-old man with refractory ascites due to nephrotic syndrome and chronic heart failure who developed an incarcerated umbilical hernia. Color Doppler ultrasonography allowed us to detect clearly visible blood-flow signals in the incarcerated bowel and rule out necrosis, which is a contraindication for reduction. Several attempts at manual reduction failed; ultrasonography-guided reduction revealed that fluid collection within the hernia sac was blocking the manual pressure directly on the incarcerated bowel toward the hernia orifice. After sac paracentesis (draining the fluid from the sac), the incarcerated bowel became palpable, leading to a successful reduction. Four days later, once the patient was in a stable condition, an elective surgery was performed to prevent the recurrence of incarceration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We believe that this is a useful report on the use of point-of-care ultrasonography for incarcerated hernia from the initial assessment of bowel viability to reasonable hernia reduction through hernia sac paracentesis according to real-time observation. An approach based on visualization by ultrasonography, and not on the operator's experience, would be rational, and we believe that this approach will be feasible for emergency physicians, who are responsible for the initial treatment of incarcerated ventral hernia.