Poster (R2)- #STPE46 - KEYWORDS: Abdominal pain, physical exam, hernial orifices, quality improvement

Abdominal Pain and Examination of Hernial Orifices

Sotirios G. Doukas MD1, Shikha Jha, MD1 and Abdelbaky Mohamed, MD1
1Department of Medicine, Saint Peter’s University Hospital/ Rutgers University, New Brunswick, NJ

ABSTRACT:
History and physical examination are the foundations for identifying the underlying etiology and assessing the severity of a disease. A complete physical examination in patients with abdominal pain requires examination of hernia orifices [1,2,3]. An inguinal hernia is a common medical condition, and complications deriving from the strangulation of an existing hernia can be devastating and can potentially lead to death [1]. We hypothesize that examining hernia orifices is not performed and documented in every patient with acute abdominal pain as suggested by the medical literature. Inclusion criteria: We included 1) patients with a chief complaint of abdominal pain in period 2.24.20-5.31.20, 2) patients who were admitted to the hospital, and patients who were discharged from the Emergency Department (given patients that visited the ED but not admitted >> patients that were finally admitted, all the admitted patients were included), 3) Patients with documented physical examination Exclusion criteria: 1) patients < 19 –years old, examination performed by the authors of this study, 2) patients without abdominal pain as a chief complaint, 3) patients admitted for elective procedures in the hospital, 4)patients with no or incomplete documentation. A total of 100 patients were included in the study. Examination of hernial orifices was performed overall in 2 out of 100 cases (2%). Specifically, a hernial orifice examination was conducted in one ED case by an ED physician and in one inpatient case by a Medicine Teaching Service resident. The general surgery service was consulted in 8 cases, and an examination of hernial orifices was performed in one of the cases (12.5%). The gastroenterology service was consulted in 10 cases, and examination of hernial orifices was not performed in any of these cases. This retrospective study showed that examination of hernia orifices is rarely performed in cases of acute abdominal pain. The lifetime risk for inguinal hernia is 27% in men and 3% in women [3]. Emergency Medicine physicians, Medicine physicians, and consultants should perform and document examination of the hernial orifice in every patient encounter with chief complaints of abdominal pain. 1. Silen W. Cope’s Early Diagnosis of the Acute Abdomen: 22nd Edition. oxford univ press. 2010;99(1):42. 2. Condon RE, Nyhus LM. Complications of groin hernia and of hernial repair. Surg Clin North Am. 1971;51(6):1325-1336. 3. Amerson JR. Inguinal Canal and Hernia Examination. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990.