Large bowel obstruction from incarcerated inguinal hernia

Case contributed by RMH Core Conditions

Presentation

Day 4 post CABG. In ICU. Distended and tense abdomen.

Patient Data

Age: 80 years old
Gender: Male

Multiple dilated loops of small and large bowel consistent with obstruction. Locule of gas seen to overlie the left obturator foramen would suggest left inguinal hernia as the cause.

Left inguinal hernia containing sigmoid colon is demonstrated. This causes a mechanical large bowel obstruction, with marked proximal large and small bowel dilatation. Smaller direct right side inguinal hernia.

No free intra-abdominal fluid or gas. No pneumatosis or convincing bowel wall hypoenhancement to suggest ischemia.

  • Yellow arrows = gas projecting over the left inguinal region (always abnormal). 
  • Green arrows = dilated small bowel loops. 
  • Red arrows = dilated large bowel loops.
    • Note how the sigmoid colon has a relativel abrupt cut-off at the level of the femoral head.
  • Blue arrows = absent rectal gas. 

Case Discussion

The hernial orifices are a "check" (must-look) area on abdominal radiographs. Hernias are an uncommon cause of large bowel obstructions. 

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