Strangulated para-umbilical hernia: sonographic features
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.
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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.
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
- 1. Stavros AT, Rapp C. Dynamic ultrasound of hernias of the groin and anterior abdominal wall. Ultrasound Q 2010; 26:135–169.
- 2. Jamadar DA, Jacobson JA, Morag Y, et al. Characteristic locations of inguinal region and anterior abdominal wall hernias: sonographic appearances and identification of clinical pitfalls. AJR Am J Roentgenol 2007; 188:1356–1364.