A large left-sided inguinal hernia in a 65-year-old man is explored. At operation, the sigmoid colon is found to form part of the posterior wall of the hernial sac itself, so the sac cannot be simply ligated at its neck. Which statement best describes this condition?

• A It is a Richter's hernia, in which only the antimesenteric border is trapped
• B It is a sliding hernia, more common on the left side, where the viscus forms the wall of the sac ✓
• C It is a direct hernia passing through Hesselbach's triangle
• D It is an interparietal hernia lying between the layers of the abdominal wall

Explanation

In a sliding (en glissade) hernia, a retroperitoneal organ such as the sigmoid colon, caecum, or bladder prolapses and forms part of the wall of the sac. It is commoner on the left because of the sigmoid colon. The practical surgical implication is that the sac cannot be ligated at the neck in the usual way, since doing so would injure the bowel; the viscus must be reduced and the peritoneum closed medial to it. Richter's hernia involves only a portion of the circumference, not the sac wall.

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.