Adhesions within abdominal wall hernia
Large abdominal wall mass and intermittent severe abdominal pain with vomiting. Small hernia inferior to mass. ? Incarcerated hernia.
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Mild proximal small bowel dilation and faecalisation of small bowel content within a large ventral hernia indicating a low-grade small bowel obstruction. The transition point is within the hernia. Fibrous brands within the hernia sac are present, indicating adhesions. No evidence of perforation or bowel ischaemia.
The hernia orifice is not the cause of obstruction in this case, as the hernia has a broad neck, and the transition point is within the hernia, not at the abdominal wall. Multiple fibrous brands are present, indicating adhesions within the hernia sac as the underlying aetiology.