Presentation
Severe abdominal pain, associated with nausea and vomiting for one week. History of anterior abdominal wall hernia repair many years ago.
Patient Data
Multiple dilated bowel loops with air fluid levels noted in the central abdomen. No pneumoperitoneum is seen.
a defect measuring 25 mm is seen in the anterior abdominal wall above and to the right side of the umbilicus. Another defect measuring 18 mm is seen in the anterior abdominal wall inferior and to the right side of the umbilicus. Herniation of fat and parts of the distal ascending colon is noted through these defects. Herniated bowel is associated with diffuse dilatation of the bowel proximal to it (proximal ascending colon and small bowel) and collapse of the bowel distal to it (transverse and descending colon) with the level of bowel obstruction/transition point noted in the smaller inferior defect. No pneumoperitoneum is seen
a well-defined collection measuring 5.7 x 5.6 cm (average density=29 HU) is seen in the hernial sac between the herniated bowel loops; hematoma or abscess ?
a defect measuring 23 mm is seen in the supra-umbilical midline anterior abdominal wall. Herniation of only fat is noted through this defect
large hiatal hernia
Postoperative day 3
Multiple surgical staples suggestive of recent surgery are seen projecting over the central abdomen. Diffuse dilatation of the bowel likely representing postoperative ileus is noted. Nasogastric tube and an external drain are seen in place.
Case Discussion
Operation notes:
few anterior abdominal wall hernias, with two hernias containing part of the distal ascending colon which was viable. A mesh, likely related to the previous surgery, along with a hematoma also noted in the hernial sac. Multiple adhesions were noted between the bowel and anterior abdominal wall as well as between the intrabdominal bowel loops
hernias were repaired. Adhesiolysis was also done. The patient did well postoperatively and was discharged after one week