A strangulated inguinal hernia is operated on. The sac contains a collapsed but viable-looking loop of ileum, yet the patient has features of established small bowel obstruction with peritonism. The most likely explanation is:

• A Richter's hernia with gangrene of the antimesenteric border
• B Maydl's hernia, where a W-shaped loop is strangulated within the abdomen while the sac contains viable bowel ✓
• C Sliding hernia with caecal volvulus
• D Littre's hernia containing a strangulated Meckel's diverticulum

Explanation

In Maydl's hernia the sac contains two adjacent viable loops connected by a third loop that has returned to the abdominal cavity and become strangulated there, the classic 'en W' configuration. The surgeon who judges severity by the contents of the sac alone will miss dead bowel inside the abdomen, so the efferent and afferent loops must be traced and delivered. Richter's and Littre's strangulation occurs within the sac itself, which contradicts the viable sac contents described here.

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.