Acute onset of left inguinal swelling, developed overnight. History of left sided hernia repair 15 years ago.
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Small bowel loop is noted in the hernial sac with surrounding fluid. The hernial neck measures 4 mm.
Vascularity is preserved in the herniated segment.
Intraperitoneal segment of small bowel shows wall thickening (5 mm).
No dilatation of small bowel loops in abdomen.
The patient was taken to theater and a femoral hernia was diagnosed (thought to be an inguinal hernia on the pre-operative ultrasound). Part of bowel wall was in the sac. Because the surgeon had doubt about origin of hernia, the incision was made directly over the site of swelling.