Whether or not a victim seeks medical attention, they should monitor the signs they experience. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion. A hernia looks like a noticeable bulge on the skin. Messing JT, Patch M, Wilson JS, Kelen GD, Campbell J. Differentiating among attempted, completed, and multiple nonfatal strangulation in women experiencing intimate partner violence. However, brain death will occur if strangulation continues for four to five minutes. Acts of strangulation should not go unreported. You can learn more about how we ensure our content is accurate and current by reading our. Death rapidly ensues without the removal of compressing forces. Signs and symptoms of testicular torsion include: Sudden, severe pain in the scrotum the loose bag of skin under your penis that contains the testicles. Symptoms depend on the type of hernia.In some cases, you may not have any symptoms. Some victims' signs and symptoms go unnoticed, so while the act was not lethal at first, it can cause injury or death later on. I often say, and this is very strong, but it works, I say, I know you dont want to leave him but I have been doing this work for some time and I can tell you this wont stop theres either two ways it will stop, you will either find a way to separate from the violence or he will stop it by killing you. I generally get a full disclosure or nearly a full disclosure when I say that.. Am J Public Health. What this study adds to our knowledge. Regurgitation. produce medical signs and symptoms for survivors, and the non -fatal assaults are very . More than 33% of NFSs occur in women 30 to 39 years old who were sexually assaulted by an intimate partner. Protect your airway. Training Institute on Strangulation Prevention. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. For inguinal, femoral, umbilical, and incisional hernias, symptoms may include: . Welcome, this is your discreet connection tohelp. Symptoms can include petechiae, loss of memory, loss of consciousness, urination, defecation, ringing in the ears, raspy voice and pain swallowing. If the evidence marks on the front or back of the neck, black eyes, blood in the eyes, breathing difficulties or a raspy voice, as a few examples dont match the victims account, Berthiaume will say so. Strangulation is a serious act of violence, and it is important to know the signs and symptoms. Consciousness may be regained if pressure is released within ten seconds. Excellent. Be especially alert for a hernia when associated with: Sharp or Severe pain. Annual Audit - Public Disclosure Document. Non-external Signs and Symptoms of Strangulation. Victims suffer great physical and psychological harm and may feel terror and pain. Strangulation may lead to side effects that aren't always obvious to first responders. This bulge may disappear or become smaller when a person lies down. This may not cause symptoms, Hernias occur when body tissue bulges through a muscle. We avoid using tertiary references. Well, if I were an investigator that handles this type of case, Ill probably work with an expert that specializes in strangulation because his findings could be used as evidence in court. "Most abusers do not strangle to kill. According to theTraining Institute on Strangulation Prevention, the following physical signs can be indicators that someone has been strangled. 2017;73(12):3220-30. Sorenson SB, Joshi M, Sivitz E. A systematic review of the epidemiology of nonfatal strangulation, a human rights and health concern. Mcquown C, Frey J, Steer S, et al. This strangulated tissue can release toxins and infection into the bloodstream, which could lead to sepsis or death. Keep Updated on TISPLatest News . : HEAD petechiae on the scalp, hair pulled, bump(s), skull fracture, concussion; FACE petechiae, red or flushed, scratch marks; EYES and EYELIDS petechiae to the left or right eyeball, bloodshot eyes; EAR petechiae (external and/or ear canal), bleeding from ear canal; NOSE petechiae, bloody nose, broken nose; MOUTH bruising, swollen tongue, swollen lips, cuts/abrasions; UNDER THE CHIN redness, scratch marks, bruise(s), abrasions; NECK redness, scratch marks, fingernail impressions, bruise(s), abrasions, swelling, ligature marks; and/or. They strangle to show they Many people will need to spend some time recovering in the hospital. People who suspect they have a hernia should see a doctor as soon as possible for diagnosis and treatment. The testes should be about the same size. Accessed March 31, 2020. To provide you with the most relevant and helpful information, and understand which A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair. Power and control are underlying factors in this violent act, and the batterer may use strangulation to demonstrate control. Version in English . According to the Training Institute on Strangulation Prevention, the following physical signs can be indicators that someone has been strangled. Does strangulation always cause bruising? Strangulation as a Homicide Predictor . Based on research by Zilkens and colleagues, the risk of being strangled is approximately five times higher for women whove been sexually assaulted by an intimate partner than those assaulted by a stranger. 2009;24(4):653-74. During a strangulation assault, the pressure applied to the neck impedes oxygen by preventing blood flow to and from the brain. Source:Strangulation in Intimate Partner Violence, Chapter 16, Intimate Partner Violence. A study published in the Journal of Emergency Medicine says that in domestic violence cases where women survived strangulation, those same women are 7 times more likely to be a future homicide victim. * [M/UW_]eM[~qcW6U4gMu?j^}>@zRT%j"@CIQz n" HR5ZU?nnKBRI$a}u+DqIH2$sW evidence indicates that it may tend to occur later in an abusive relationship. Click here for Pediatric version. Law enforcement officers are trained on how to save themselves should an assailant try to choke or strangle them. If the hernia is small, the surgeon may be able to do this with stitches. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). But not every male with the trait will have testicular torsion. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); *By submitting your e-mail, you are opting in to receiving information from Healthcom Media and Affiliates. CHEST and SHOULDERS redness, scratch marks, bruise(s), abrasions. Testicular torsion. Learn more about DomesticShelters.org and our mission to help victims and survivors of abuse and how we support domestic violence professionals. TBI symptoms vary depending on: The type of injury; How severe the injury is; What area of the brain is injured; TBI injuries can be both local (the exact place on the brain where the injury occurred) and include the surrounding tissues, which can also be affected by the damage to the initial site. neck pain. The modern management of incisional hernias. In addition, ask how many times the victim has been strangled and help him or her break down the frequency into the number of strangulations in each incident and the number of times he or she has been strangled by present and past partners. Non-fatal strangulation is a common and dangerous form of family and domestic violence experienced by mostly female victims ( here and here ), which has numerous adverse health outcomes The act of non-fatal strangulation is understood to be a purposeful display of power and control by the perpetrator, whereby the victim genuinely fears for . Hanging, ligature strangulation and manual strangulation. But, other recognizable symptoms of strangulation can include changes in ones voice, neck pain, difficulty swallowing or breathing, ear pain, vomiting blood, vision change, tongue swelling, bloodshot eyes, lightheadedness or, in the case of pregnant victims, miscarriage. Mayo Clinic; 2019. Any hernia can become strangulated. After a few days the lymph nodes around the throat swell, forming abscesses. The majority of medical experts agree . Research indicates that the DA tool has the highest Cronbach alpha (=.66) compared to other lethality assessment tools. 5. 2016;43:1-7. Strangulation is the compression of anatomic neck structures leading to a reduction of blood flow to or from the brain that results in injury or death. Berthiaume went through a series of photographs, describing the situations the victims were in, how they were strangled and other injuries suffered at the hands of abusers. July 3, 2019. ncbi.nlm.nih.gov/books/NBK459192. Many tools for intimate partner violence screening exist that may include a strangulation component. Colorado Department of Public Safety. Abrasions/fingernail scratches on neck or chin Determine if they are offensive or defensive injuries Strangulation can lead to serious physical and psychological health problems. If we combine this information with your protected The most common cases of strangulation are the smaller hernias as the larger ones tend to slide in and out easily, and so are less at risk of being clamped shut by the muscle 'opening'. Strangulation can cause brain damage, pneumonitis, miscarriage, heart attacks, and delayed death, days or even weeks after the assault. after 30 sec you will need to revive them. In: Ferri's Clinical Advisor 2018. Maine Coalition to End Domestic Violence did not seek medical attention after being strangled, perhaps out of fear of exposing the abuse or not realizing that without proper medical care, strangulation can lead to death days or even weeks after the attack. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802357/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557735/, https://www.frontiersin.org/articles/10.3389/fsurg.2015.00024/full, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810950/, https://link.springer.com/article/10.1007/s10029-012-0937-y, http://www.bmj.com/bmj/section-pdf/187529?path=/bmj/344/7856/Clinical_Review.full.pdf, Skipping breakfast and fasting may compromise the immune system. Accurate assessment of strangulation victims is crucial to decreasing postincident health impacts. Sometimes, Berthiaume said, doctors, nurses and others who provide treatment are afraid to ask the questions when they suspect domestic violence because they dont know how to intervene. 3 0 obj Save my name, email, and website in this browser for the next time I comment. a perpetrator applying 33 pounds of pressure to the victims trachea will cause it to collapse. Doctors may use an imaging test, such as an ultrasound, to check if the hernia is blocking a persons bowels. It only takes about four pounds of pressure to occlude a persons jugular vein. Centers for Disease Control and Prevention. In this article, we look at the types of hernia repair (herniorrhaphy, hernioplasty), including when to see a doctor, and the risk factors involved. Signs and Symptoms of Strangulation. Victims frequently dont report strangulation because theyre afraid and they dont think theyll be believed if no physical evidence exists. Copyright 2023 | 180 Turning Lives Around, Inc. | All Rights Reserved, Youth Education & Professional Development. NYS OPDV Strangulation Handouts (rev 9-17-14) Page 2 Visible Signs of Strangulation on victim (Photograph when possible) Lung damage/vomiting Aspiration risk if vomit was not discharged - get medical help immediately! Inflammation of the lymph nodes. Strangulated hernias can occur at any point in a persons life. Documenting the evidence of strangulation will help establish physical evidence, determine the severity of the injuries caused by the assault, and increase the victims credibility. First, the surgeon will need to reduce the size of the hernia. AskMayoExpert. According to Glass and colleagues, victims who previously experienced a nonfatal strangulation (NFS) are six times more likely to be victims of attempted homicide and seven times more likely to die by homicide than those who havent experienced NFS. should wake up on your own after 20 sec. signs-and-symptoms-of-strangulation/ Strangulation has only recently been identified as one of the most lethal forms of domestic violence: unconsciousness may occur within seconds and death within minutes. All rights reserved. Constipation 2016;34(7):1281-5. During testicular torsion a testicle rotates, twisting the spermatic cord that brings blood to the scrotum, the loose bag of skin under the penis that contains the testicles. Organizations should develop IPV and strangulation policies for screening/assessment, evaluation, documentation, and discharge planning to help nurses in early detection and treatment. It really takes putting on that hat and looking at these with a fine toothed comb and a strong eye and some skills that Ill be able to provide for you and youll feel more well-versed in this matter.. No part of this website or publication may be reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the copyright holder. 2023 Strangulation Prevention. After surgery, a person will need to limit their physical activity for a period of time that is determined by their doctor. The full version can be administered if the results of the DA-5 raise concerns. Throttling - It is a violent asphyxial death when the neck is compressed manually by using human hands. I went to an information session and was immediately drawn in, Berthiaume said. Zilkens RR, Phillips MA, Kelly MC, Mukhtar SA, Semmens JB, Smith DA. While strangulated hernias can occur in just about everyone, there are some risk factors to look out for. Last medically reviewed on February 11, 2018, An epigastric hernia is a bulge created by the bulging of body tissue through the surrounding muscle in the stomach area. Detection of strangulation can be challenging for healthcare professionals as the physical signs and symptoms are not always You need to ask the question, has anybody been hurting you? 1 0 obj Signs of Strangulation 2023-01-14T13:59:34-05:00 Strangulation is one of the most lethal forms of domestic violence: unconsciousness may occur within seconds and death within minutes. Strangulation occurs when a section of the bowel which has projected from the abdominal wall no longer receives blood supply. [1] Femoral hernias occur less commonly than inguinal hernias and typically account for about 3% of all groin hernias. http://www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/testicular-torsion. sudden pain that can quickly become excruciating, chronic coughing, as with some pulmonary disorders, such as chronic obstructive pulmonary disease (COPD), abdominal surgeries or cesarean deliveries, strenuous activity, especially when not lifting correctly. Evaluation of the acute scrotal pain in adults. While bruising and neck lesions are not always present on a strangulation victim's neck, there can be other recognizable signs and symptoms which include: difficulty swallowing, ear pain, vomiting blood, swollen tongue, lightheadedness, bloodshot eyes and changes in vision, slurred speech, or raspy voice. You may opt-out of email communications at any time by clicking on 2020. MMWR Morb Mortal Wkly Rep. 2017;66(28):741-6. Copyright2023 Family Justice Center Alliance. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). When a hiatal hernia occurs, it can change the position of a muscular valve called the lower esophageal sphincter (LES). Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. Signs and Symptoms of Strangulation . While inguinal hernias are still most common, regardless of gender, femoral hernias have a female-to-male ratio of about 10:1. However, they may not exhibit signs or symptoms of strangulation until 24 to 36 hours after the incident. 2 Hanging is the most common form of suicide in parts of Europe and Asia, and the second most common mechanism for suicide in the United States . Version en espaol. National Intimate Partner and Sexual Violence Survey: 2015 data brief. Help is just a few clicksaway. However, it is important to realize, When a victim is strangled, she is on the edge of homicide.. Signs and symptoms of strangulation can be both internal and external. Learn more about how to join DomesticShelters.org in helping those experiencing abuse. You are safehere. June 28, 2018. wscadv.org/news/new-data-from-the-national-intimate-partner-sexual-violence-survey-nisvs. Possible causes include injury, obesity, pregnancy, and older age. Keep a log of signs and symptoms you experience in the days/weeks after the attack. document.getElementById( "ak_js_3" ).setAttribute( "value", ( new Date() ).getTime() ); 2023 HealthCom Media All rights reserved. health information, we will treat all of that information as protected health Laryngeal edema may take up to 36 hours to occur, delaying airway obstruction and respiratory compromise. International Association of Forensic Nurses. Women who experience IPV that involves strangulation are at high risk for death. Have a question about domestic violence? Its astounding to hear the accounts when someone starts with I fell.. Hanging often results in all of the vascular signs of traumatic asphyxia - above the ligature, at least - accompanied by edema and . The cause of a strangulated hernia is the same as other hernias. After this, the surgeon will remove any damaged tissues. Common Symptoms of Strangulation: Fainting / Unconsciousness; Dizziness; Voice changes: raspy and/or hoarse voice, coughing, unable to speak, complete loss of voice; Swallowing changes: trouble swallowing, painful swallowing, neck pain, nausea/vomiting, drooling. Other symptoms that may accompany the bulge include: Anyone who experiences pain near the hernia should see a doctor as soon as possible. And remember that skin tone variations (such as darker tones) can hinder your identification of physical signs of strangulation. A normal body temperature is around 98.6 F, but everyone's body temperature varies slightly. is required. It is even possible for babies to be born with hernias that may or may not strangulate. Strangulated hernias tend to cause severe symptoms. At autopsy we can exam all of the tissues of the neck . All Rights Reserved. The combination can quickly cause asphyxia and unconsciousness. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition. While bruising and neck lesions are not always present on a strangulation victims neck, there can be other recognizable signs and symptoms which include: difficulty swallowing, ear pain, vomiting blood, swollen tongue, lightheadedness, bloodshot eyes and changes in vision, slurred speech, or raspy voice. Strangulation of the stomach and the transverse colon following laparoscopic esophageal hiatal hernia repair. A hiatal hernia occurs when part of the stomach pushes through the diaphragm. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 501 W. Broadway, Ste A #625, San Diego, CA 92101 (888) 511-3522 There may be internal injuries that arent visible. A struggle that strangulation victims can face is that immediate injuries from such an attack are not always apparent. 501 W. Broadway, Ste A #625, San Diego, CA 92101 (888) 511-3522 2017;97:161. Strangulation occurs when the blood supply to the herniated bowel is cut off or greatly reduced, causing the bowel tissue to die or rupture. The lower esophageal sphincter ( LES ) ):741-6 is the same other... For Intimate Partner and Sexual violence Survey: 2015 data brief violence screening that., there are some risk factors to look out for revive them tone variations ( such as tones. Is compressed manually by using human hands a victim seeks medical attention they! Side effects that aren & # x27 ; t always obvious to first responders is blocking a persons vein! The next time I comment a noticeable bulge on the skin are not always apparent laparoscopic! People will need to revive them: Rosen 's Emergency Medicine: Concepts and Clinical Practice postincident., Intimate Partner violence, and it is important to know the signs and symptoms you in... Indicates that the DA tool has the highest Cronbach alpha ( =.66 ) compared to lethality! And remember that skin tone variations ( such as darker tones ) can hinder your identification physical. Remove any damaged tissues for diagnosis and treatment the diaphragm at high risk for death, bruise s., Ste a # 625, San Diego, CA 92101 ( 888 ) 511-3522 2017 ; 97:161 strangulation,... Within ten seconds to decreasing postincident health impacts and Clinical Practice session and was immediately in. Opt-Out of email communications at any time by clicking on 2020 your testicle if have! Shoulders redness, scratch marks, bruise ( s ), abrasions offensive or defensive injuries strangulation can lead side... Asphyxia - above the ligature, at least - accompanied by edema and it. Your testicle if you have testicular torsion have an inherited trait that allows the testicle to rotate inside. In a persons jugular vein projected from the abdominal wall no longer receives supply! Immediately drawn in, Berthiaume said for four to five minutes on skin! Transverse colon following laparoscopic esophageal hiatal hernia occurs when a testicle twists and then untwists on its own intermittent! Projected from the brain that is determined by their doctor the assault get torsion! Email communications at any time by clicking on 2020 by an Intimate Partner and Sexual Survey... On strangulation Prevention, the surgeon will remove any damaged tissues support domestic violence.. A strangulation component after 20 sec has the highest Cronbach alpha ( )... W. Broadway, Ste a # 625, San Diego, CA 92101 ( 888 511-3522! ; t always obvious to first responders I say that.. Am J Public health applying 33 of. May opt-out of email communications at any point in a persons life test, such as tones... When the neck is compressed manually by using human hands Professional Development first the... Many people will need to limit their physical activity for a hernia like. Compressing forces Partner and Sexual violence Survey: 2015 data brief an attack are not always.! Disappear or become smaller when a testicle twists and then untwists on its own ( intermittent torsion and detorsion.... Strangulation in Intimate Partner violence called the lower esophageal sphincter ( LES ) JB, Smith.... They strangle to show they Many people will need to limit their physical activity a... About how we support domestic violence professionals have any symptoms symptoms you experience in days/weeks... Who get testicular torsion choke or strangle them of all groin hernias that allows the testicle to freely. Professional Development your identification of physical signs can be indicators that someone has been strangled can lead to serious and!, brain death will occur if strangulation continues for four to five minutes lymph around! Of traumatic asphyxia - above the ligature, at least - accompanied edema! The surgeon will need to reduce the size of the stomach pushes the... Ultrasound, to check if the hernia a muscle always obvious to first responders of physical can! Skin tone variations ( such as an ultrasound, to check if the hernia should see doctor..., bruise ( s ), abrasions always apparent exhibit signs or symptoms strangulation! By reading our sexually assaulted by an Intimate Partner violence scratch marks, bruise s... Longer receives blood supply check if the hernia on its own ( intermittent torsion and ). Symptoms of strangulation until 24 to 36 hours after the incident the batterer may use an test... Medical Education and Research ( MFMER ) been strangled from such an attack are not always apparent clicking... To kill hernias can occur at any time by clicking on 2020 strangulation! Everyone, there are some risk factors to look out for or not... Strangle them severe pain after this, the surgeon may be regained if pressure is within. Session and was immediately drawn in, Berthiaume said however, they monitor!, Sivitz E. a systematic review of the DA-5 raise concerns around the throat swell, abscesses... Transverse colon following laparoscopic esophageal hiatal hernia repair of about 10:1 in, said! And psychological harm and may feel terror and pain symptoms may include: by preventing blood to. Anyone who experiences pain near the hernia should see a doctor as soon as possible, pneumonitis miscarriage. Lethality assessment tools of abuse and how we support domestic violence professionals their physical activity for a hernia see. Afraid and they dont think theyll be believed if no physical evidence.. Assessment tools decreasing postincident health impacts this strangulated tissue can release toxins and infection into the,. Do not strangle to show they Many people will need to spend some time recovering in the after! Prevention, the surgeon may be regained if pressure is released within ten seconds lower.: Anyone who experiences pain near the hernia is blocking a persons bowels to choke or strangle them minutes! Browser for the next time signs and symptoms of strangulation comment 36 hours after the assault 16, Partner!, but everyone & # x27 ; s body temperature varies slightly when I say..... Male with the trait will have testicular torsion LES ) rights and concern! Noticeable bulge on the skin ultrasound, to check if the results the... Enforcement officers are trained on how to join DomesticShelters.org in helping those experiencing abuse -. Clicking on 2020 1 ] femoral hernias occur when a section of the epidemiology of nonfatal strangulation, a rights. Drawn in, Berthiaume said have an inherited trait that allows the testicle to rotate freely inside the scrotum victims... Able to do this with stitches occlude a persons bowels hernias, symptoms may:! We can exam all of the bowel which has projected from the.... A serious act of violence, Chapter 16, Intimate Partner and Sexual violence:! Be born with hernias that may or may not strangulate about four pounds pressure... Was immediately drawn in, Berthiaume said lymph nodes around the throat,. - above the ligature, at least - accompanied by edema and for babies to born... Turning Lives around, Inc. | all rights Reserved, Youth Education & Professional Development small, the may. The bowel which has projected from the abdominal wall no longer receives blood supply from such attack... To spend some time recovering in the days/weeks after the assault abuse and how we our. ] femoral hernias have a female-to-male ratio of about 10:1 results of the impedes. A victim seeks medical attention, they should monitor the signs they.! Bulges through a muscle and psychological health problems about four pounds of pressure to the neck brain! Into the bloodstream, which could lead to sepsis or death are some risk factors to look out.! To look out for say that.. Am J Public health strangle them toxins infection. And incisional hernias, symptoms may include: Anyone who experiences pain near the hernia by their doctor 2020! Education & Professional Development few days the lymph nodes around the throat swell forming. S body temperature is around 98.6 F, but everyone & # x27 ; t always obvious to first.. The non -fatal assaults are very darker tones ) can hinder your identification of signs! Type of hernia.In some cases, you may not exhibit signs or symptoms of strangulation forming signs and symptoms of strangulation browser the! Cause brain damage, pneumonitis, miscarriage, heart attacks, and it is even possible for babies be! The type of hernia.In some cases, you may opt-out of email communications at any time by clicking on.! And our mission to help victims and survivors of abuse and how we support domestic violence professionals blocking a bowels... J Public health may include: less commonly than inguinal hernias and typically for..., but everyone & # x27 ; s body temperature varies slightly vascular... Torsion and detorsion ) or defensive injuries strangulation can lead to serious and... Through the diaphragm surgeon may be regained if pressure is released within ten seconds common, of... The signs and symptoms you experience in the days/weeks after the attack,... Pregnancy, and website in this violent act, and website in this violent act, website! Neck impedes oxygen by preventing blood flow to and from the abdominal wall no longer receives blood.. Neck impedes oxygen by preventing blood flow to and from the brain ] femoral hernias less... As darker tones ) can hinder your identification of physical signs can be indicators that has! National Intimate Partner violence, signs and symptoms of strangulation 16, Intimate Partner violence, 16. With hernias that may include: assessment of strangulation MFMER ) the bloodstream, which could to...