Where does this leave our four-year-old patient? He is extremely unlikely to have Hib meningitis, since he is fully vaccinated. And we have to make the decision to give dexamethasone right now to get the potential benefit. Logically, he should not receive steroids since the benefit does not outweigh the risks unless it is Hib. And that is going to be true in almost any other child you see with meningitis unless you know that the child is highly likely to have Hib disease. When would you know this? Maybe if the child is unvaccinated and has had close contact with a patient with known Hib disease. Other than that, there is probably no way you could suspect Hib disease in time to dose with steroids.
In babies, umbilical hernias may heal themselves within four years, making surgery unnecessary. For all other hernias, the standard treatment is conventional hernia-repair surgery, called herniorrhaphy. It is possible to simply live with a hernia and monitor it. The main risk of this approach is that the protruding organ may become strangulated (have its blood supply cut off), and infection and tissue death may occur as a result. A strangulated intestinal hernia may result in intestinal obstruction, causing the abdomen to swell. The strangulation can also lead to infection, gangrene, intestinal perforation, shock, or even death.