Large bowel obstruction - umbilical hernia

Case contributed by Palak Thakrar
Diagnosis almost certain

Presentation

Patient with history of lung carcinoma with liver metastases. Presented with history of distension of the abdomen.

Patient Data

Age: 60 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

There is a ventral abdominal wall defect measuring 3.4 x 3.0 cm in the umbilical region. Mid segment of the transverse colon herniates through the defect. There is mild dilation of the cecum and ascending colon. Loops of small bowel are also mildly dilated. There is no free fluid in abdomen or pelvis. Tiny pockets of air are seen in the adjacent anterior abdominal fat. There is no evidence of fat stranding in the umbilical region.

Multiple ill-defined hypoattenuating liver lesions are compatible with metastases.

Case Discussion

A large umbilical hernia with herniation of the mid-segment of the transverse colon in the anterior abdominal wall with resultant obstruction of the proximal small and large bowel loops. 

Multiple liver lesions are consistent with the history of liver metastases.

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