Inguinal hernias with mechanical small bowel obstruction

Case contributed by Abdallah Mohamed


Severely ill patient presented with left groin swelling, absolute constipation and vomiting for the last 4 days.

Patient Data

Age: 80 years
Gender: Male

Scout from CT abdomen shows multiple central dilated small bowel loops suggestive of small bowel obstruction.

Marked dilatation of the small bowel loops with caliber up to 5 cm down to a transition point at the left groin where a strangulated femoral hernia containing small bowel loop with poor enhancement is noted. The small bowel distal to the transition point is collapsed as well as the colon The bowel wall enhancement is borderline.

Moderate intra-peritoneal free fluid.

Bilateral pantaloon inguinal hernias noted with bladder content on the left direct one and bowel content at the left indirect one.

Bilateral pulmonary lower lobe consolidation collapse with right lower lobe area of breakdown and early abscess formation. 

Bilateral small pleural effusion more on right.

NGT decompresses the stomach.

Case Discussion

The patient underwent a laparoscopic reduction of the hernia with resection and anastomosis of a long segment of the small bowel due to ischemia.

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