• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Pharmacology
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Social Determinants of Health
    • Toxicology
    • Trauma
    • Ultrasound
    • Urology
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
      • Structured Interview
      • Communication Case
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Incarcerated Ventral Hernia of T-colon Resulting in Colon Perforation and Intraabdominal Abscess

Shu-Chen Han, MD*

*Tainan Municipal Hospital, Taiwan, Department of Radiology, Taiwan, Province of China

Correspondence should be addressed to Shu-Chen Han, MD at han520719@gmail.com

DOI: https://doi.org/10.21980/J83W74 Issue 4:4
Abdominal/GastroenterologyVisual EM
No ratings yet.

Creative Commons images
Creative Commons images
Creative Commons images
Creative Commons images
Creative Commons images
Creative Commons images
Creative Commons images

History of present illness:

A 75-year-old female with a remote history of rectal cancer presented to the emergency department with acute right upper abdominal pain. The pain had begun suddenly after lunch. On review of systems, the patient had mild nausea. Initial vital signs were within normal limit. She denied fever, chills, or vomiting. The physical examination revealed a distended, tympanic abdomen with tenderness to palpation in the right upper quadrant. Laboratory examinations revealed a white-blood-cell count of 8.73 x 103 with 86% neutrophils. C-Reactive protein value was 1.17 mg/dL. She had a history of rectal cancer status post low anterior resection 14 years prior to this visit.

Significant findings:

Computed tomography (CT) showed herniation of stool-filled, thin-walled colon through a narrow abdominal wall defect (green circle). Associated stranding of herniated fat is also seen (blue arrow). The narrow neck of the hernia sac and the fat stranding suggest incarceration. An abscess containing gas bubble secondary to perforation was observed in the vicinity of hepatic flexure (red circle).

Discussion:

Ventral hernias generally occur as a result of previous surgery or trauma. The incidence ranges from 2 % to 20%.1 Ventral hernias include all hernias of the anterior and the lateral abdominal wall.2,3 Midline hernias are more common. Paramedian or lateral defects are less common, but have a high prevalence of incarceration.1 The diagnosis of ventral hernias is still challenging without accepted diagnostic standards.4 Computed tomography scan is the recommended diagnostic tool if diagnosis cannot be made by physical examination. If the incarceration is not reduced, strangulation might occur and may lead to perforation.5,6 In patients with an acutely incarcerated or strangulated ventral hernia, emergent surgical consultation is warranted. An open rather than a laparoscopic approach is suggested.4 Intravenous broad-spectrum antibiotics should be started if obstruction is suspected or fever, leukocytosis is present. This case illustrates a ventral hernia of the colon resulting in acute colon obstruction, perforation of hepatic flexure, and intra-abdominal abscess. Emergency surgery is an essential part of treatment.

The patient in this case underwent laparotomy with right hemicolectomy and intra-abdominal abscess drainage. The patient subsequently received multiple operations because of anastomosis leakage and iatrogenic duodenal injury. The patient was discharged after 90 days of hospitalization.

Topics:

Ventral Hernia, incarceration, perforation.

References:

  1. Le Huu NR, Mege D, Ouaissi M, Sieleznezneff I, Sastre B. Incidence and prevention of ventral incisional hernia. J Visc Surg. 2012:149(5): e3-14.doi: 10.1016/j.jviscsurg.2012.05.004.
  2. Aguirre DA, Santosa AC, Casola G, Sirlin CB. Abdominal wall hernia: imaging features, complications, and diagnostic pitfalls at multi-detector row CT. 2005;25(6):1501-1520. doi: org/10.1148/rg.256055018.
  3. Lassandro F, Iasiello F, Pizza NL, et al. Abdominal hernias: radiological features. World J Gastrointest Endosc. 2011;3(6):110-117. doi: 4253/wjge.v3.i6.110.
  4. Birindelli A, Sartelli M, Saverio SD, et al. 2017 update of the WSES guideline for emergency repair of complicated abdominal wall hernias. World J Emerg Surg.2017; 12:37. doi: 1186/s13017-017-0149-y.
  5. Skelly BL, Neill Obstructed hepatic flexure contained in right-sided inguinoscrotal hernia resulting in a caecal perforation. Ann R Coll Surg Engl. 2013;95(6): e102-104. doi: 10.1308/003588413X13629960047551.
  6. Ota S, Noguchi T, Takao T, et al. An incarcerated colon inguinal hernia that perforated into the scrotum and exhibited an air-fluid level. Case Rep Med. 2015;1-3.  doi: 1155/2015/105183.
Icon

Colon Perforation and Abscess - Case Report

1 file(s) 857 KB
Download
Icon

Colon Perforation and Abscess - Images

1 file(s) 4.5 MB
Download
CTIssue 4:4

Reviews:

No ratings yet.

Please rate this





Creative Commons images

Ultrasonographic Findings of Acute Achilles...

06 Oct, 19
Creative Commons images

Thoracic Aortic Aneurysm Measured by Point of...

06 Oct, 19

JETem is an online, open access, peer-reviewed, journal-repository for EM educators. We are PMC Indexed.

Most Viewed

  • The Silent Saboteur: Teaching the Clinical Implications of Occult Hypoxemia & Social Determinants of Health via a Pulmonary Embolism Case
  • Diabetic Ketoacidosis and Necrotizing Soft Tissue Infection
  • My Broken Heart
  • Stabilization of Cardiogenic Shock for Critical Care Transport, a Simulation
  • Innovative Ultrasound-Guided Erector Spinae Plane Nerve Block Model for Training Emergency Medicine Physicians

Visit Our Collaborators

Creative Commons Licence
This work is licensed under a Creative Commons Attribution 4.0 International License.

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright Creative Commons Attribution 4.0 International