A strangulated inguinal hernia is explored. The sac contains two loops of small bowel connected by an apparently normal-looking intervening segment. The patient has signs of intestinal obstruction disproportionate to what lies in the sac. What is the diagnosis?

• A Richter's hernia
• B Intersigmoid hernia
• C Sliding hernia
• D Hernia-en-W (Maydl's hernia) ✓

Explanation

Maydl's hernia, also called hernia-en-W, contains two loops of bowel in the sac with a connecting loop retained in the abdominal cavity. The strangulated middle loop lies intra-abdominally and cannot be inspected through the sac, so gangrene may be missed if the surgeon judges viability from the sac contents alone. The entire relevant bowel must be delivered and examined. Richter's involves a single knuckle of anti-mesenteric border and does not produce this configuration.

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.