Question 1620
{"accessible":true,"alternatives":[{"id":8067,"text":"Amyand hernia"},{"id":8069,"text":"De Garengeot hernia"},{"id":8068,"text":"femoral hernia "},{"id":8070,"text":"direct inguinal hernia"},{"id":8071,"text":"indirect inguinal hernia"},{"id":8072,"text":"obturator hernia"}],"archived":false,"correctAlternativeId":8068,"explanation":"\u003cp\u003eDilation of small bowel loops secondary to entrapment in a hernia\u0026nbsp;sac located medially to the lower epigastric vessels is identified. This excludes the diagnosis of indirect inguinal hernia (which remain lateral) and makes us consider the differential diagnosis between direct inguinal hernia (hernia\u0026nbsp;sac above the inguinal ligament) and femoral hernia (hernia\u0026nbsp;sac below the inguinal ligament).\u003c/p\u003e\u003cp\u003eIn this case, the hernia\u0026nbsp;sac is located medial to the lower epigastric vessels and below the inguinal ligament, so the diagnosis is of femoral (crural) hernia.\u003c/p\u003e\u003cp\u003eIf this femoral hernia contained the appendix, the diagnosis would be De Garengeot's hernia, but in this case, the hernia\u0026nbsp;sac contains only small bowel loops.\u003c/p\u003e\u003cp\u003eAmyand's hernia is a rare case of inguinal hernia containing the appendix.\u0026nbsp;\u003c/p\u003e\u003cp\u003eFinally, the obturator hernia would be in a deeper location, in the obturator region.\u003c/p\u003e","id":1620,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/148/crural_rp_big_gallery.jpeg","imageAttribution":{"kind":"own","user_id":45033,"user_param":"edlomar","user_name":"Edgar Lorente"},"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/1620","nextQuestionPath":"/articles/amyand-hernia-1/questions/250","relatedArticles":[{"id":6236,"title":"Direct inguinal hernia","link":"/articles/direct-inguinal-hernia?lang=us"},{"id":7111,"title":"Obturator hernia","link":"/articles/obturator-hernia?lang=us"},{"id":23937,"title":"Femoral hernia","link":"/articles/femoral-hernia?lang=us"},{"id":827,"title":"Abdominal hernia","link":"/articles/abdominal-hernia?lang=us"},{"id":12533,"title":"Inguinal hernia","link":"/articles/inguinal-hernia?lang=us"},{"id":1499,"title":"Indirect inguinal hernia","link":"/articles/indirect-inguinal-hernia?lang=us"},{"id":29454,"title":"De Garengeot hernia","link":"/articles/de-garengeot-hernia?lang=us"},{"id":71235,"title":"Hernia (general)","link":"/articles/hernia-general?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eThis 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT\u0026nbsp;is performed with selected images shown. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1620"}],"attemptsPercentages":[{"alternativeId":"8072","percentage":6},{"alternativeId":"8071","percentage":17},{"alternativeId":"8070","percentage":21},{"alternativeId":"8068","percentage":34},{"alternativeId":"8069","percentage":7},{"alternativeId":"8067","percentage":15}],"promptToLogin":false,"questionManager":false,"articleId":"amyand-hernia"}