Presentation
Weakness, feculent vomiting.
Patient Data
Numerous small bowel loops dilated up to 3.5 cm, with air-fluid levels, up to incarcerated right femoral hernia. Bowel loops distal to the hernia are collapsed. Small amount of feces along the colon, rectal fecaloma. Small amount of intraperitoneal fluid. Small bowel loops surround the colon - malrotation?
Moderate intrahepatic bile duct dilatation; severe common hepatic duct (CHD), cystic duct, and common bile duct (CBD) dilatation; mild pancreatic duct dilatation - all seen on previous CT abdomen 3 years earlier (not shown) but has worsened; papillary stenosis.
Small amount of right pleural effusion.
NGT in the stomach.
Case Discussion
Nursing home dweller with dementia and end-stage renal failure. Brought to the ER due to weakness and feculent vomiting. Diffuse abdominal tenderness, and feculent material in the NGT.
CT abdomen showed small bowel obstruction due to an incarcerated right femoral hernia. The contents of the hernia were thought to be a focal wall of the ileum but at surgery, turned out to be a partly ischemic Meckel diverticulum. A Meckel diverticulum incarcerated in a femoral hernia is termed a Littre hernia.
Unable to process the form. Check for errors and try again.