A 60-year-old man with an incarcerated inguinal hernia undergoes emergency surgery. The surgeon finds two separate loops of ileum within the hernial sac. The loop connecting them lies within the abdominal cavity and is gangrenous, while both loops in the sac appear viable. What is this entity called?

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

Explanation

Maydl's hernia, also called retrograde or W-shaped hernia, contains two loops of bowel in the sac connected by a third loop inside the abdomen. Because the constricted neck compresses all three loops, the middle intra-abdominal loop is the one that typically strangulates, and it may be missed if the surgeon inspects only the sac contents. Littre's hernia contains a Meckel diverticulum and Richter's hernia involves only one antimesenteric border, so neither fits the finding of two loops in the sac.

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.