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Special Feature
March 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Department of Surgery, University of Illinois at Chicago. Dr Prieto is now with the Department of Surgery, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, NY.

 

GRACE S.ROZYCKIMD

Arch Surg. 2007;142(3):305. doi:10.1001/archsurg.142.3.305

A 79-year-old African American woman with right lower quadrant pain and a palpable right lower quadrant mass was evaluated on 2 prior occasions, once as an outpatient and once in the emergency department. A working diagnosis of a right inguinal hernia was made. On both occasions, the hernia was reduced and managed nonoperatively because of her medical comorbidities. The patient returned to our emergency department with recurrence of symptoms. Initial examination revealed a normal abdomen with a moderate-sized bulge in the right lower quadrant. However, the patient rapidly developed increased abdominal distention, as seen in Figure 1. The intraoperative findings are shown in Figure 2.

Figure 1.
Computed tomographic scan of the abdomen showing incarcerated bowel (arrow).

Computed tomographic scan of the abdomen showing incarcerated bowel (arrow).

Figure 2.
Loop of small bowel that was incarcerated with perforation.

Loop of small bowel that was incarcerated with perforation.

What Is the Diagnosis?

A. Retroperitoneal sarcoma

B. Right inguinal hernia

C. Spigelian hernia

D. Ventral hernia

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