At operation for a strangulated inguinal hernia, the surgeon finds two separate loops of ileum within the sac. After delivering both loops, the segment connecting them, which lay within the abdomen, is found to be gangrenous while both intra-abdominal-sac loops appear viable. This entity is called:

• A Richter's hernia
• B Pantaloon hernia
• C Maydl's hernia ✓
• D Sliding hernia

Explanation

Maydl's hernia is a retrograde (W-shaped) hernia in which two loops of bowel lie in the sac and the intervening loop lies inside the abdominal cavity. Because the constricted loop is intra-abdominal, it is hidden from view at the neck of the sac, and the gangrenous segment can be missed if the surgeon does not pull out and inspect the connecting loop. This is the classic trap of Maydl's hernia and why the whole W must be delivered.

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.