[Skip to Content]
[Skip to Content Landing]
October 11, 1976

An Unusual Hernia

Author Affiliations

Loyola University Medical Center Maywood, Ill

JAMA. 1976;236(15):1694. doi:10.1001/jama.1976.03270160018019

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


To the Editor.—  I enjoyed reading the case report on "An Unusual Hernia" (235:2813, 1976) in The Journal. The authors suggest that the gastric perforation was secondary to the incarceration and "were surprised that the gastric perforation had occurred within the abdomen rather than within the hernial sac."I would like to suggest that, in my experience, the sequence of events is just the reverse of that postulated by the authors. I believe that peritonitis occurs first (in this case due to gastric perforation), and as a consequence of the peritoneal soiling and resulting ileus, the hernial contents are pushed further into the sac and become irreducible.It is an axiom of abdominal surgery that one should never "explain" a generalized peritonitis on the basis of an incarcerated hernia. To do so usually results in a nonproductive exploration of the hernia while recognition of the true source of difficulty (appendicitis,