The primary concerns with hernias are that they can entrap, or as we call incarcerate or strangulate, tissues such as fat, blood vessels, and more commonly and worrisome ... the intestines. An incarcerated or strangulated intestine is a true medical emergency. Sometimes, the hernia allows trapped intestinal arterial high pressure blood to go through its opening, but the lower pressure venous blood attempting to return to the abdominal cavity cannot get past the tightness of the hernia opening, and the intestinal tissue becomes more swollen, leaky, tender, and the process becomes a vicious cycle. Bacteria become trapped as well, and the intestine can become completely cut off from its blood supply and perforate, become gangrenous, and can lead to death in the worst case scenario.
If there is pain, nausea, vomiting, tenderness, fevre, blood in the stool, black stool, or a painful lump in the hernia ... it's an emergency and be seen in the emergency room ASAP. Time is tissue ... don't wait. It's SO much easier to deal with and repair hernias when they are not emergencies. See your surgeon and plan for this to be repaired. One year is too long to have waited.
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He really does need to have this repaired while he's young, and especially while it's not strangulated or an emergency. This sounds like a right inguinal hernia. Eventually, his intestines (that's what the lump is) can fall down into his scrotum and become strangulated. It needs to be addressed surgically, and my preference would much rather be that it be done electively rather than under emergency or life-threatening circumstances.
He should avoid lifting anything over 10 pounds. There are inguinal hernia belts that can be used as a temporary measure, but they are old school and can potentially lead to a feeling that he doesn't need this addressed surgically, another crutch he doesn't need -- plus they're incredibly uncomfortable and can put pressure on the testicular arteries, vas deferens, and testicular veins. With a hernia his size, I wouldn't recommend this remotely.
It is serious. The surgery is simple and most often can be done laparoscopically as an outpatient procedure ... sometimes an overnight stay at most. He does need to consult with a General Surgeon soon. Sooner is better.
-- XXXXX XXXXX, MD