Image of the Month—Quiz Case

An 83-year-old white man presented with a 10-day history of left lower quadrant abdominal discomfort. He described progressive bloating and cramping that would intensify until he obtained relief with a feeling of sudden release and an explosive bowel movement. This process would repeat every 36 to 48 hours. His surgical history was remarkable for having had bilateral open inguinal hernia repairs 20 years previously. The patient denied groin pain. Physical examination revealed bilateral inguinal hernia scars and tenderness to deep palpation in the left lateral and left lower portions of the abdomen. A computed tomographic scan was obtained (Figure 1).

Figure 1. 

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Computed tomographic scan showing bowel incarcerated within a hernia sac at the junction of the lateral border of the left rectus sheath and semilunar line.

A. Spigelian hernia

B. Richter hernia

C. Littre hernia

D. Combined spigelian and Richter hernias