Large bowel obstruction due to incisional hernia
Known umbilical hernia. More pain for 2 days, vomiting and not opened bowels last 1 day. Abdominal wall feels hard and indurated.
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The midline anterior abdominal wall hernia contains a loop of large bowel, with marked dilatation of the large bowel proximal to the hernia. The distal large bowel is collapsed. There is no free gas but there is some inflammatory fat stranding in the hernia sac.
The patient underwent a successful reduction and repair of the hernia. The presence of fat standing in a large hernia sac with a narrow neck is a marker of incarceration, and patterns of enhancement should be closely scrutinised to evaluate for bowel ischaemia and strangulation.