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Special Feature
Nov 2012

Image of the Month—Diagnosis

Author Affiliations


Arch Surg. 2012;147(11):1066. doi:10.1001/archsurg.147.11.1066

Computed tomography identified a right paramedian hernia containing the right gastroepiploic artery and a portion of the omentum with fluid and stranding, suspicious for incarceration (Figure 2). No attempt at reduction had been made prior to the scan because of the pulsatile nature of the hernia on physical examination. Confirmation of arterial involvement from the imaging study prompted surgical reduction under direct visualization.

Paramedian ventral hernia repair was performed through her prior incision. Intraoperatively, we found a hernia sac containing omentum with the right gastroepiploic artery. No evidence of strangulation was seen. The hernia contents were reduced and the hernia sac was excised. The nonfunctioning PD catheter was removed. The hernia defect was closed primarily using nonabsorbable, braided, polyester sutures. A tunneled dialysis catheter was placed for temporary intermittent hemodialysis, and the patient was discharged without any complications.