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Incarcerated femoral hernia due to foreign body

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Abdominal pain with distension, vomiting and painful swelling at the left groin.

Patient Data

Age: 80 years
Gender: Male

Distended small bowel with a transition point at the level of the left femoral canal where there is a small incarcerated femoral hernia containing a linear hyperdense foreign body (Fish bone) piercing the bowel wall with surrounding fat stranding. No extraluminal gas is seen.

Other findings:

  • mixed hiatal hernia

  • simple hepatic and renal cysts

  • epigastric hernia containing preperitoneal fat

Case Discussion

CT features most consistent with incarcerated left femoral hernia due to a foreign body perforating the bowel wall. At surgery, the foreign body was a fish bone which was confirmed later by the patient that was ingested accidentally 2 days ago.

Fish bone is considered one of the most common accidentally ingested foreign bodies. Usually eliminated without any complication. Gastrointestinal tract perforations are relatively rare (<1% of the cases) 1,2 and require surgery. CT is the best imaging modality to identify the nature and location of the ingested foreign body and its complications 1.

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