A man with a strangulated inguinal hernia has two separate loops of ileum within the sac, yet he reports frequent loose stools rather than absolute constipation. Which anatomical feature of this Maydl hernia explains the finding?
- A Only the antimesenteric border of one loop is trapped, so luminal continuity is preserved
- B One of the two loops contains a Meckel diverticulum that secretes mucus into the lumen
- C The hernial ring compresses only the mesentery, leaving both loops viable
- D The two loops in the sac are joined by a third loop that remains inside the abdomen, and this concealed middle segment is the strangulated one ✓
Correct answer: D. The two loops in the sac are joined by a third loop that remains inside the abdomen, and this concealed middle segment is the strangulated one
Explanation
In a Maydl or W-shaped hernia, two limbs of bowel occupy the sac while the intervening loop stays within the peritoneal cavity. The hidden middle loop is often the segment that becomes gangrenous, and because it lies inside the abdomen the classic obstructive picture may be replaced by diarrhoea from the irritated bowel, misleading the clinician. Option A describes a Richter hernia, which involves only one antimesenteric border of a single loop.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.