How should I manage a patient with an incarcerated inguinal hernia in the absence of strangulation signs?

In managing a patient with an incarcerated inguinal hernia without signs of strangulation, the immediate priority is to arrange an urgent referral to general surgery for surgical assessment and management. This is because an irreducible or partially reducible hernia, even in the absence of strangulation, carries a risk of progression and complications, warranting prompt specialist evaluation NICE CKS.

Emergency hospital admission is reserved for cases where there are suspected serious complications such as strangulation or intestinal obstruction, which are not present in this scenario NICE CKS.

For adults, urgent referral to general surgery should be made to consider surgical repair, as elective surgery has lower morbidity compared to emergency surgery if complications develop later NICE CKS. The European Hernia Society guidelines similarly support surgical repair for incarcerated hernias to prevent progression to strangulation, emphasizing timely intervention HerniaSurge Group 2018.

Conservative management or watchful waiting is generally not appropriate for incarcerated hernias due to the risk of ischemic complications, even if strangulation signs are absent at presentation NICE CKS. However, in minimally symptomatic or reducible hernias without incarceration, watchful waiting may be considered based on clinical judgement and patient comorbidities NICE CKS.

In summary, the recommended management for an incarcerated inguinal hernia without strangulation is urgent surgical referral for assessment and likely repair, avoiding delay that could lead to strangulation and emergency surgery NICE CKS; HerniaSurge Group 2018.