# Strangulated or Incarcerated Hernia (Emergency) - Category: emergency - Review status: reviewed (every claim checked against a document named on this page) - Sources: International guidelines for groin hernia management (HerniaSurge Group) 2018 · Manual reduction of hernia under analgesia/sedation (Taxis) in the acute inguinal hernia: a literature review (Hernia 2020) · Paracetamol 10 mg/ml solution for infusion SmPC section 4.2 (eMC product 15148) · 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias (World J Emerg Surg 2017;12:37, PMC5545868) - Verified date: 2026-08 ## Verified against - 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias (World J Emerg Surg 2017;12:37, PMC5545868) - Paracetamol 10 mg/ml solution for infusion SmPC section 4.2 (eMC product 15148) ## Treatment metadata - No drug therapy required (Emergency Surgical Referral) - Paracetamol — 1000 mg — injection ## Complete treatment card ```text STRANGULATED OR INCARCERATED HERNIA (EMERGENCY) Sources: International guidelines for groin hernia management (HerniaSurge Group) 2018 · Manual reduction of hernia under analgesia/sedation (Taxis) in the acute inguinal hernia: a literature review (Hernia 2020) · Paracetamol 10 mg/ml solution for infusion SmPC section 4.2 (eMC product 15148) · 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias (World J Emerg Surg 2017;12:37, PMC5545868) Review status: REVIEWED against 2 sources listed above (2026-08) 1. NO DRUG THERAPY REQUIRED (EMERGENCY SURGICAL REFERRAL) [1st line] Adult Refer to emergency surgery the same hour. Nil by mouth from the moment of suspicion, start IV fluids, and arrange transfer without waiting for imaging or blood results. WSES: emergency repair immediately when intestinal strangulation is suspected (grade 1C). - Immediate - within the hour Peds An infant or young child with an irreducible groin or umbilical lump, vomiting, or inconsolable crying needs the same immediate transfer. Incarceration is commonest in the first year of life, when the processus vaginalis is still patent. Source 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias (World J Emerg Surg 2017;12:37, PMC5545868) Why A hernia that will not go back and hurts is a blood-supply problem, not a hernia problem. Nothing in a clinic reverses it and every hour of delay costs bowel. Caution SURGICAL EMERGENCY: refer immediately when strangulation is suspected (WSES 2017, grade 1C). The risk of strangulation roughly doubles for every 24 hours of delay. Do NOT wait for fever, tachycardia or a white-cell count. WSES states the classic clinical signs alone are unreliable for early detection - what predicts strangulation is SIRS, lactate, CPK, D-dimer and contrast CT, none of which should hold up a referral from a clinic. Do NOT force manual reduction (taxis) if there is any sign of strangulation - dusky or discoloured overlying skin, peritonism, or a systemically unwell patient. Bowel that has infarcted will not reduce, and forcing it risks pushing dead bowel back inside the abdomen where the damage is hidden. This one is standard surgical practice rather than a numbered WSES recommendation. Bowel obstruction on its own does not rule reduction out, but reduction is a decision for the surgeon in hospital. It is never a reason to keep the patient in the clinic. Highest risk of incarceration: women, femoral hernias, and anyone previously admitted for a groin hernia (HerniaSurge 2018). Treat a groin hernia in a woman as femoral until a surgeon says otherwise. Nil by mouth means no oral analgesia, no oral fluids and no laxative. Elective repair carries roughly 0.1% mortality; emergency surgery for strangulated bowel is an order of magnitude worse. The difference is made in the first few hours. 2. PARACETAMOL [add-on - not a substitute] Adult 1 g by intravenous infusion over 15 minutes for pain during transfer. Minimum 4 hours between doses, maximum 4 g in 24 hours (3 g if under 50 kg, malnourished, or with hepatic risk factors). - Single dose during transfer Peds Two weight bands, which is why no single card is shown. At or below 10 kg: 7.5 mg/kg per infusion, maximum 30 mg/kg/day. Above 10 kg to 33 kg: 15 mg/kg per infusion, maximum 60 mg/kg/day not exceeding 2 g. 33-50 kg: 15 mg/kg, not exceeding 3 g/day. At least 4 hours between doses. Incarceration is commonest in the first year of life - that is the 7.5 mg/kg band, and giving 15 there is a double dose. Source Paracetamol 10 mg/ml solution for infusion SmPC section 4.2 (eMC product 15148) Why Oral analgesia is the wrong route here because the patient has to stay nil by mouth for theatre. IV paracetamol is widely registered in Egypt and cheap - a 1 g vial starts around 15 EGP. Caution Check the weight band before drawing up. Intravenous paracetamol at double dose is hepatotoxic in an infant, and 10 kg is the line. Analgesia must not delay transfer, and it must never be given instead of one. Give it on the way out of the door. Adequate pain relief does not hide the diagnosis. Withholding analgesia to keep the abdomen 'readable' is an old habit with no evidence behind it. Lengthen the interval to 6 hours if creatinine clearance is 30 mL/min or less. Avoid an NSAID: it adds bleeding and renal risk before an operation and can blunt the very signs the surgeon is looking for. Egypt EUPIFALGAN 1GM/100ML VIAL FOR I.V. INF. 100 ML EIMC 15.00 EGP RAZIPHEMOL 1 GM/100ML SOLN. FOR I.V. INF. GRAND PHARMA > ELRAZY PHARMACE... 22.50 EGP TARGECETAL 1 GM/100ML VIAL FOR I.V. INF. GRAND PHARMA > GRAVITY PHARMA 22.50 EGP PERFALGAN 1 GM/100ML SOL. FOR I.V. VIAL UPSA FRANCE SUBSIDIARY OF BMS >... 39.75 EGP MEDALGESIC 1 GM VIAL I.V. INF. 100 ML ARABCOMED 60.00 EGP PARACPIMOL 1 GM/100ML VIAL FOR I.V. INF. DELTA GRAND PHARMA > ARAX PHARM... 67.00 EGP ROTAPYRETIC 1 GM/100ML VIAL FOR I.V. INF. GRAND PHARMA > BIOCAPITAL PHARMA 67.00 EGP GAMPYRCETAL 1 GM/100ML VIAL FOR I.V. INF. BADR PHARMA > GAMA PHARMA 73.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)