Strangulated Hernia

A 4 year old boy presented with a 2 days history of strangulated hernia (part of the bowel protruding through a small opening out of the abdominal cavity, if it;s so small, the bowel cannot get back into the abdominal cavity and therefore lose blood supply and part of the bowel could die. He came by canoe costing the family their savings 240kina which is about £35 pounds for the petrol for the canoe. It took them 6 hours on canoe. When we saw him he had a swollen, red, tender hernia which basically means he needs to be seen by the surgeon now!! if he presented in A&E in UK. As it was two days that he has had it, it may mean that the bowel had already died. There's a trick to reducing hernia I have learned, which is pulling the hernia (of course once again using the amazing ketamine anaesthetic to put the child asleep so he will not scream and fidget), then the content of the bowel slowly drains away and slowly by slowly the bowel goes through the small opening and so the hernia is reduced. It still means he needs surgery to close the opening as he has risk of the bowel coming through the opening again. Well luckily this time the hernia was reduced, it was not red or painful anymore. As I said the family has already used all their savings to get to Kikori, so there is no way they have money to go to the capital general hospital to get the surgery. This is where the oil company comes in handy. After discussing with the doctor there, they agreed that the risk is high and he should be transported to Port Moresby. They will pay for the return plane ticket to Port Moresby. Praise God! And I was so happy to see him have a bowel movement the next day (which means part of that bowel had not died).