A strangulated inguinal hernia is explored. Two separate loops of ileum are found within the sac, and the surgeon notes that the intervening loop connecting them remains inside the abdomen. The gangrenous segment is most likely to be:

• A Both loops within the sac
• B The intermediate loop within the abdomen ✓
• C Only the proximal loop within the sac
• D The caecum forming the posterior sac wall

Explanation

Maydl's hernia is a W-shaped hernia in which two adjacent loops lie in the sac while the connecting middle loop stays in the abdominal cavity. Because the neck of the sac constricts the mesentery of this hidden middle loop, it is the intra-abdominal segment that becomes strangulated, and it can be missed if only the visible sac contents are inspected. The caecum as part of the sac describes a sliding hernia, not Maydl's.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.