Large bowel obstruction secondary to ventral hernia

Case contributed by Dr Henry Knipe

Presentation

Six weeks of intermittent vomiting, anorexia, LOW. Reduced bowel actions ?bowel obstruction or upper GI malignancy.

Patient Data

Age: 79
Gender: Female
CT

Abdomen/Pelvis

Dilatation of the caecum and ascending colon and demonstrates bowel wall thickening. There is an anterior abdominal wall hernia. The hernial orifice measures 40 mm in diameter and the hernial sac contains intra-abdominal fat and the loop of transverse colon. The transition point is at the hernial orifice and the appearance is consistent with a proximal to mid large bowel obstruction due to the anterior abdominal wall hernia.

Extensive diverticulosis is noted throughout the remainder of the colon with bowel wall thickening in the sigmoid colon but no pericolic fat stranding to suggest acute diverticulitis. There is a trace of fluid in the right pericolic gutter. No free intraperitoneal gas to suggest perforation.

There is a small hypodensity in segment 2 of the liver measuring 7 mm in diameter which is probably a cyst. There is intra and extrahepatic biliary tract dilatation.There are several calcified gallstones in the gall bladder. The common bile duct measures 11 mm in diameter and there are several filling defects in the distal common bile duct consistent with choledocholithiasis. The pancreas and adrenal glands are unremarkable. There are several cortical cysts in the kidneys with the largest in the left lower pole measuring 12 mm in diameter. The abdominal aorta is ectatic measuring 21 mm in maximum diameter. No para-aortic or pelvic lymphadenopathy. No suspicious skeletal lesions demonstrated.

Conclusion:

1. Proximal to mid large bowel obstruction due to an anterior abdominal wall hernia. No free intraperitoneal gas to suggest perforation.

2. Calcified gallstones in the gall bladder. Intra and extrahepatic bile duct dilatation. Choledocholithiasis and possible cholecystitis.

Case Discussion

Large bowel obstructions secondary to ventral hernias are uncommon and are much less than small bowel obstructions. 

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Case information

rID: 28187
Case created: 14th Mar 2014
Last edited: 1st Sep 2015
Inclusion in quiz mode: Included

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