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On clinical examination pay special attention to;

Table 5: Important points on clinical examination
Overall state; distressed, comfortable, cachexia
Vital signs
State of hydration
Abdominal examination; distension, peristalsis, tenderness, mass
Hernial orifices, Perineum, Ano-rectum, Genitalia, Femoral Pulses

On clinical examination, note the important points outlined above. Evidence of a complicated obstruction would include; an unwell patient, tachycardia, hypotension, pyrexia, severe dehydration, abdominal tenderness and a leucocytosis. Such findings should accelerate the decision to proceed with surgery.

It is foolish to embark on a laparotomy if the patient has obstruction from an obvious femoral hernia. The patient may be best served by an approach directly to the hernia. So, check the hernial orifices.

Adrian P. Ireland