Abdominal Pain and Examination of Hernial Orifices: The Forgotten Art of Physical Diagnosis

Abstract

Introduction: Acute abdominal pain can be the first manifestation of a hernial pathology. The estimated risk of incarcerated hernia is 1%-3% over a person's lifetime. Therefore, hernial orifice examination should be conducted routinely, especially in cases of abdominal pain. We hypothesized that physical examination of hernial orifices is not routinely performed and documented in patients presenting with acute abdominal pain.Methods: A retrospective chart review of 100 patients who were evaluated for abdominal pain over a threemonth time frame at our institution.Results: From the 100 reviewed cases, the hernial orifice examination was performed in two cases by an Internal Medicine or Emergency Medicine physician (2%). Out of the eight cases with General Surgery consultation, only one case had hernial orifices examination (12.5%). In the 10 cases with Gastroenterology consultation, not a single case had hernial orifice examination. Conclusion:We demonstrate that hernial examination is infrequently performed in clinical practice and suggest that emphasis should be placed on the efficient performance of physical examination and maintain the art of physical diagnosis.

Incarcerated Epigastric Hernia

“…In addition, a structural deformation theory by Aksar proposed the pattern of single aponeurotic decussation over a triple decussation, which is responsible for the weakness [6]. A true epigastric hernia with obstructed contents is a medical rarity and has been reported only four times so far in the medical literature [7,8].…”