At open repair of a large long-standing right indirect inguinal hernia in a 65-year-old man, the surgeon finds that the caecum forms part of the posterior wall of the hernial sac, with no distinct peritoneal covering over it. Which statement about this hernia is correct?
- A It is a sliding hernia and the viscus must be carefully dissected free before any attempt at sac closure ✓
- B The sac should be excised completely as in a routine hernia
- C It is a Richter's hernia involving the antimesenteric border of the caecum
- D It indicates a patent processus vaginalis and is managed by high ligation alone
Correct answer: A. It is a sliding hernia and the viscus must be carefully dissected free before any attempt at sac closure
Explanation
In a sliding (en glissade) hernia the retroperitoneal caecum on the right, or sigmoid colon on the left, descends with the sac so that the viscus itself forms part of the sac wall. Blind dissection or complete excision of the sac risks opening the bowel, so the organ must be freed and returned to the abdomen before repair. Richter's hernia involves only part of the circumference of small bowel, and high ligation alone is inadequate because a true posterior wall defect exists.
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.