Presentation
Sharp abdominal pain in the setting of irreducible umbilical hernia. Alcoholic cirrhosis.
Patient Data
A short loop of small bowel is located within an umbilical hernia which has a neck measuring 25 mm transversely. Subsequently, there is a small bowel dilatation proximally and collapsed distally indicating obstruction. The large bowel is unremarkable. No free intra-abdominal gas.
The liver is small with a nodular contour and heterogeneous parenchymal attenuation in keeping with cirrhosis. There is a moderate amount of ascitic fluid around the liver and spleen and in the pericolic gutters and pelvis. The paraumbilical vein is patent. The spleen is bulky but not particularly enlarged and contains a linear cleft posteriorly. There are numerous mesenteric and omental collateral vessels. The left gastric vein is severely dilated and there are numerous gastro-esophageal varices extending into the posterior mediastinum. The main portal vein is mildly enlarged (14 mm). No portal and splenic venous thrombosis. Small incidental gallstones.
Extensive metal artefact in the right side of the chest due to previous internal fixation of the right humerus. Minor atelectasis posteriorly at the lung bases. No basal pleural effusion. No osseous abnormality.
IMPRESSION
Acute small bowel obstruction secondary to an incarcerated umbilical hernia.
Case Discussion
Hernias are more common in patients with ascites due to increased intra-abdominal pressure.
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