Strangulated para-umbilical hernia: sonographic features

Case contributed by Dr Hadiel Kaiyasah

Presentation

Patient with a history of chronic liver disease, presented with one-day history of abdominal pain & vomiting. Abdominal examination showed irreducible para-umbilical hernia, otherwise soft non-distended abdomen. Bedside ultrasound showed bowel loops within the hernia sac.

Patient Data

Age: 60-65
Gender: Female

Ultrasound images of the para-umbilical hernia showing loops of bowel within the hernia sac with edematous bowel wall. 

Small hyperechoic foci are compatible with intraluminal gas rather than pneumatosis intestinalis.

Case Discussion

Patient was posted for urgent operation. Intra-operative findings were of strangulated bowel loops. A resection and primary anastomosis was done.

This case clearly shows the importance of ultrasound in making the diagnosis of strangulation in the setting of irreducible hernia. Being non-invasive and readily available in the emergency department, this makes it advantageous over other imaging modalities in prompt surgical decision making.

Ultrasound features suggestive of bowel strangulation within a hernia sac are:

  • thickening of the hernial sac
  • presence of hyperechoic fat
  • fluid within the sac
  • dilated bowel within the sac
  • oedamatous thick bowel walls
  • loss of peristalsis
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Case information

rID: 45947
Case created: 14th Jun 2016
Last edited: 25th Oct 2016
Inclusion in quiz mode: Included

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