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Case of the Month

October 2008

Patient Data: 74 year old male

Clinical Info: Obese patient with abdominal pain and a palpable mass in the midline of the upper abdomen

The mass consists of fluid filled ring like structures

Longitudinal image of one of these ring-like structures shows a small bowel loop filled with fluid and sedimentation of bowel contents

There is fluid around the bowel loops. There is also slight thickening of the bowel wall.

The plain abdominal X ray shows a dilatated bowel loop in the midline of the upper abdomen

High frequency image of the bowel loops. The dilatated bowel loops are not covered by the abdominal wall muscles, but converge to a defect in the abdominal wall muscle layer.

A lower frequency image shows an abdominal wall hernia through which small bowel loops protrude.

Detail of the abdominal wall hernia

The patient was operated and the diagnosis non reducible epigastric hernia with incarcerated bowel loops was confirmed.

For more examples of abdominal wall hernias see

Rettenbacher T, Hollerweger A, Macheiner P, Gritzmann N, Gotwald T, Frass R, Schneider B. Abdominal wall hernias: cross-sectional imaging signs of incarceration determined with sonography. AJR Am J Roentgenol. 2001 Nov;177(5):1061-6.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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