WEST AFRICAN EMERGENCY SURGERY

Strangulated inguinal hernia — no CT, dawn theatre

15 decision points ~25 min Difficulty 4/5 Membership

Setting

You are the on-call surgical registrar at a district hospital in Ho, Volta Region. It is 20:00 on Friday. The one operating theatre is not staffed until 06:00 Saturday. The nearest tertiary centre with a CT scanner is five hours away by road.

Patient

Mr K, a 62-year-old market trader and manual labourer, arrives with his son. He has had a right groin swelling for three years which has always reduced when he lies down. Today, from noon, the swelling has been painful and will not go back. He has vomited green fluid six times over the last six hours. He has not passed flatus since morning. No prior abdominal surgery. HIV status unknown.

Reference stack

Bailey & Love 28e Ch 71 · Sabiston 21e Ch 43 · WSES 2018 emergency hernia guidelines · Cochrane 2020 anastomosis

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.