Incarcerated inguinal hernia with perforation

Case contributed by Dr Erik Ranschaert

Presentation

58 year old woman with transplant kidney and acute lower abdominal pain.

Patient Data

Age: 58
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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Case information

rID: 12532
Case created: 12th Dec 2010
Last edited: 6th Oct 2015
Inclusion in quiz mode: Included

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