A 65-year-old man with an incarcerated right inguinal hernia undergoes emergency surgery. On exploration, the bowel loops in the sac appear dusky but vascularity recovers after 10 minutes of warm saline wrapping. The sac is found to contain two loops of small intestine with a third loop incarcerated outside the abdominal cavity in an antecolic position. This represents:
- A Maydl's hernia (hernia-en-W) ✓
- B Richter's hernia
- C Littre's hernia
- D Sliding hernia
Explanation
Maydl's hernia (hernia-en-W or double-loop hernia) is characterized by two loops of bowel in the hernia sac with an intermediate loop lying intra-abdominally, forming a W configuration. The intra-abdominal loop, which lies between the two loops in the sac, may strangulate even while the sac contents appear viable. Surgeons must always inspect the intermediate intra-abdominal segment at hernia repair. Richter's hernia involves only the antimesenteric wall; Littre's contains a Meckel's diverticulum; sliding hernia has retroperitoneal viscera forming part of the sac wall.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.