Small bowel obstruction from incarcerated direct inguinal hernia

Case contributed by Dr Henry Knipe

Presentation

Bowels not open two days. Nausea.

Patient Data

Age: 90 years
Gender: Male
Dilated loops of small bowel centrally with multiple air fluid levels and a paucity of gas in the colon. Bowel gas projects over the left inguinal region including with the subsequently demonstrated hernia. No free gas.

Left direct inguinal hernia containing normally enhancing small bowel and adjacent fluid. Proximal small bowel is dilated with multiple air-fluid levels. Distal to this small bowel is collapsed. No free gas. 

Case Discussion

Hernias are the second most common cause of small bowel obstruction (10%) but are far behind adhesional small bowel obstructions (75%), which is the major cause in developing countries. Direct inguinal hernias occur through Hesselbach's triangle, and a good differentiator from indirect inguinal hernias is that they occur anteromedial (compared to anterolateral to indirect inguinal hernias) to the epigastric vessels. 

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Case information

rID: 48587
Case created: 15th Oct 2016
Last edited: 6th Dec 2016
Inclusion in quiz mode: Included

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