Small bowel obstruction due to incarcerated femoral hernia

Case contributed by Michael P Hartung


Nausea, vomiting, abdominal pain.

Patient Data

Age: 70 years
Gender: Female

High grade small bowel obstruction, with slow gradient of oral contrast -> unopacified contents.

Oral contrast helps you to quickly target the point of obstruction, as the distal small bowel before the obstruction should only have fluid (oral contrast cannot make it that far).

Incarcerated left femoral hernia.

Notice inguinal ligament "cutting across the bowel" on coronal images.

Note relationship with inferior epigastric vessels (hernia is below).

Distal small bowel is decompressed

Coronal annotated images reviewing key findings. 

Case Discussion

As you follow the small bowel from proximal -> distal, the small bowel contents are darker because they are fluid only and do not contain oral contrast. The use of oral contrast in this setting helps you to quickly find the transition point, because you can "jump ahead" to where the bowel contents are darkest (fluid only), rather than running the entire bowel.

The relationship of the hernia with the inguinal ligament and inferior epigastric vessels is key to appropriately classifying this as femoral hernia. It requires urgent surgical attention.

Case shared with me by Dr. Jeannine Ruby. 

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