ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 287

Incontrast toadhesions, ifanincarcerated hernia causes intestinal obstruction, reducing
the hernia can relieve the obstruction, which in some circumstances can be life saving.
When an unreduced hernia is identified, every effort should be made to reduce it. The indi-
vidualshouldlieflat,faceup,andasrelaxedaspossible.Ifmuchpainisbeingexperienced,
an analgesic, even an opiate, can be given to maximize muscular relaxation. The intest-
ine should be pushed back into the peritoneal cavity with gentle but continuous pressure.
A quarter of an hour or more may be required, and the process cannot be hurried. Often
the hernia contents slip back into the peritoneal cavity, and the obstruction is relieved. The
longer reduction is delayed, the more likely is compromise of the blood supply to the en-
trappedbowel.Iftheherniaisreduced,theindividualshouldbeadvisedtoevacuateassoon
as convenient. Most such individuals can hike out, although actions producing increased
intraabdominalpressurethatmaypushtheintestinebackintotheherniashouldbeavoided.
If, despite all efforts, the hernia cannot be reduced or the person continues to vomit and
show signs of obstruction, evacuation is mandatory. Antibiotics should be given in this cir-
cumstance.
Diverticulitis
Diverticulitis is inflammation ofan outpouching (diverticulum) ofthe colon, most com-
monly in the section of colon in the left lower quadrant (sigmoid colon). Although diver-
ticulitisusuallyoccursinobeseindividualsmorethanfiftyyearsold,itoccasionallyoccurs
in younger people who are not obese. The signs and symptoms of diverticulitis are sim-
ilar to acute appendicitis, but they occur on the opposite side of the abdomen. Treatment
consists of broad-spectrum antibiotics, and such individuals should be evacuated because
perforation of the colon with peritonitis may occur.
Figure 20-4 presents an algorithm that outlines the key decision points in managing an
individual with acute abdominal pain in the wilderness. The safest approach is to assume
the worst scenario and avoid delay that may risk an individual's life.
NASOGASTRIC INTUBATION
Nasogastric intubation is a highly desirable—almost essential—element in the care of in-
dividuals with intestinal paralysis (paralytic ileus) or obstruction. All the serious disorders
associated with severe, acute abdominal pain produce such paralysis; the effects are most
severe with intestinal obstruction or disorders causing peritonitis.
Large quantities of air are swallowed with food or liquids, including saliva. Gas is al-
ways present in the gastrointestinal tract, and swallowed air is the source of most of it. If
the stomach is paralyzed, its contents—including gas—cannot be expelled into the intest-
ine, and it quickly becomes ballooned with air. The distended stomach impinges on the