Hernia Complications — Obstruction, Strangulation

A 58-year-old man with a long-standing uncomplicated inguinal hernia presents with acute onset colicky abdominal pain, vomiting, and abdominal distension. On examination, the hernia is tender and irreducible. What is the most common cause of intestinal obstruction in this patient?

A 52-year-old man with a long-standing uncomplicated inguinal hernia presents with acute onset colicky abdominal pain, vomiting, and abdominal distension. On examination, the hernia is tender, irreducible, and tense. Which of the following is NOT a typical feature of strangulated hernia compared to simple obstruction?

A 52-year-old man with a known left inguinal hernia presents to the emergency department with acute onset severe left groin pain, abdominal distension, and bilious vomiting for 6 hours. On examination, the hernia is tender, irreducible, and tense. Abdominal examination reveals distension with visible peristaltic waves. Plain abdominal X-ray shows small bowel obstruction with air-fluid levels. What is the most appropriate immediate next step in management?

A 38-year-old woman with a 2-year history of a right femoral hernia presents with sudden onset right groin pain and a palpable, firm, tender mass. She has mild abdominal distension and mild discomfort on deep palpation. Bowel sounds are present. Plain abdominal X-ray is normal with no air-fluid levels. What is the most appropriate immediate next step in management?

A 52-year-old man with a long-standing ventral hernia presents with acute abdominal pain, vomiting, and abdominal distension. On examination, the hernia is tender, tense, and non-reducible. Which clinical feature best distinguishes strangulation from simple obstruction in this hernia?