Just a bleeding hernia

Authors: Francesca Malcolm, Graham Johnson / Editor: Mark Winstanley / Reviewer: Graham Johnson / Codes: Published: 29/03/2022

A 72-year-old gentleman presents to the ED with a 3 week history of intermittent abdominal pain; it is now constant in nature and 8/10 in severity. It originates from an umbilical lesion and radiates into the RIF. He has felt nauseated for several days but has not vomited. He opened his bowels yesterday, passing normal stool. He is still passing flatus and has no urinary symptoms.

He is worried as he has been increasingly lethargic and has lost a lot of weight over the past 8 months.

His GP has diagnosed an umbilical hernia which has been present for several months. It is no longer reducible and has become hard. 1 month ago the ‘hernia’ started bleeding and was cauterised by the GP.

He has a past medical history of of atrial fibrillation, myocardial infarction, coronary artery bypass grafting, hypertension and heart failure.

All observations are stable.

On examination there is a red 3-4cm, umbilical mass which is crusted with blood. The surrounding area is tender and it has a negative cough impulse. Bowel sounds are unremarkable.

Deranged blood results of note: lactate 2.7, CRP 56

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