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Case 141: Vomiting, constipation and an abdominal lump

1. What is the diagnosis?

Incarcerated and obstructed paraumbilical hernia.

2. What part of the bowel is incarcerated and obstructed by the hernia.?

The mid transverse colon - as seen to be the cutoff on the abdominal Xray.

3. What are the options for treatment?

The treatment is operative.
Open reduction of the hernia, inspection of the colon for viability, if viable, return to the abdominal cavity, hernia repair +/- mesh.

If the colon is not viable then this will require resection.
The options then include a right hemicolectomy and primary anastomosis. This operation has the benefit of using small bowel for anastomosis with its excellent blood supply, and also resects the caecum which was obstructed and can occasionally become compromised due to distension.

When a colonic resection is performed many surgeons would elect not to insert mesh to reinforce the hernia repair for fear of infection, although there is no firm evidence for this.