Examination

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.