Incarcerated inguinal hernia with bowel perforation

Case contributed by Erik Ranschaert
Diagnosis certain


History of transplant kidney now presents with an acute lower abdominal pain.

Patient Data

Age: 60 years
Gender: Female
A transplant kidney is located in the right lower fossa. Inguinal herniation of bowel structures on the right side. The bowel structures in the hernial sac are thickened, show enhancement in the wall. The hernia contains a layer of free air.

Case Discussion

25% of men and 2% of women develop inguinal hernias in their lifetime. The more commonly reported complications of unrepaired inguinal hernias include incarceration and strangulation of intestinal structures that are trapped in the hernial sac.

Intestinal loops trapped inside a hernia are susceptible to perforation. On CT, bowel perforation is suspected with the presence of free intraperitoneal air or free fluid, as is demonstrated in this case. 

CT findings of intestinal incarceration or strangulation with perforation may include: 

  • extravasated oral contrast material
  • bowel wall thickening
  • bowel wall enhancement
  • bowel wall discontinuity

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