Small bowel obstruction secondary to direct inguinal hernia

Case contributed by Dr Henry Knipe

Presentation

Vomiting and abdominal distension.

Patient Data

Age: 70 years
Gender: Male

Small bowel obstruction secondary to a right inguinal region hernia. The hernial orifice is directly anteromedial to the origin of the inferior epigastric arteries. The hernia sac is directed towards the midline, mimicking the course of the contralateral inguinal canal. The hernia sac contains obstructed small bowel as well as the cecal pole as well as a small volume of free fluid. The right colon is inferiorly displaced. Small bowel mesenteric fat stranding and free fluid. No free intraperitoneal gas.

Focal fatty infiltration adjacent to ligamentum teres. Simple renal cortical cysts. Remaining solid organs are unremarkable. Bibasal atelectasis.

Case Discussion

The differential diagnosis for this hernia is an indirect inguinal hernia, direct inguinal hernia and femoral hernia. The key landmark in this case is the origin of the inferior epigastric arteries - the hernial orifice is at the level of the inferior epigastric arteries favoring an inguinal hernia over a femoral hernia, and the hernial orifice is anteromedial to the origin in keeping with a direct hernia whereas indirect hernias have an orifice anterolateral to the inferior epigastric arteries. 

By the time the patient proceeded to the theater, the hernia had spontaneous reduced. An inguinal hernia repair was performed.

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Case information

rID: 57292
Published: 3rd Mar 2018
Last edited: 4th Mar 2018
Inclusion in quiz mode: Included

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