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James L. Berk, MD; James Weaver, MD; Edward Siegler, MD
Cleveland

JAMA. 1978;240(17):1855-1856.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

The recognized clinical findings described in textbooks of surgery of patients with a strangulated hernia are intense abdominal pain, tenderness, a high WBC count, and, if untreated, a progressive downhill course.

After transfer to this hospital and treatment of the cardiogenic shock, our patient became asymptomatic and had none of the classic findings of strangulated bowel except occult blood in the stool, which could be otherwise explained: she had no pain, was hungry, took a full diet, and had normal-appearing stools. The minimal tenderness of the hernia was inconstant on admission and disappeared completely within a few hours. The patient stated that the hernia had been present for four years and that she did not think it was any different at this time. The diagnosis at the first hospital was septic shock following a flu-like illness. The hernia was not prominent and did not enter into their differential . . . [Full Text PDF of this Article]

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