At surgery for a strangulated inguinal hernia, two separate loops of ileum are found within the hernial sac. Which segment of bowel is at greatest risk of gangrene in this situation?

• A Both loops within the sac equally
• B Neither, since both limbs remain viable
• C The proximal loop within the sac
• D The connecting loop lying inside the peritoneal cavity ✓

Explanation

This is a Maydl hernia, in which a W-shaped loop of bowel lies partly in the sac and partly in the peritoneal cavity. The constricted neck compresses both entering and exiting limbs, so the intermediate loop within the abdomen becomes a closed loop that strangulates while the sac contents may look healthy. The surgeon must always withdraw and inspect the intraperitoneal loop before closing, otherwise gangrenous bowel is left behind.

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.