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(a, b) CT scan. Bowel herniation through the right posterolateral abdominal wall (arrows).
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CT scan showed a large, incarcerated, posterolateral abdominal hernia with free fluid and possible free air and distended bowel loops indicative of obstruction (Figures 1(a) and 1(b)).
(a, b) Operative findings. Hemorrhagic small bowel segment (arrow).
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The small bowel was eviscerated from a 4 cm minilaparotomy using her old subumbilical midline incision, and the hemorrhagic loop did not recover and seemed unsalvageable (Figure 2(a)). The anastomosis was created using a GIA-75 stapler, and the damaged small bowel loop (Figure 2(b)) was resected together with the common enterotomy with a second transverse staple load.
Laparoscopic findings. Large lumbar hernia (arrows) with the colon trapped inside.
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The hernia was noted to be large, with the hepatic flexure partially trapped in it (Figure 3).
(a, b) CT. Right-sided retroperitoneal hematoma with pseudoaneurysm (arrows).
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CT scan the next day identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery as source of the hematoma (Figures 4(a) and 4(b)).
Angiography. Lumbar pseudoaneurysm (arrows).
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This was subsequently embolized by interventional radiology (Figure 5).
(a-c) Follow-up CT scan (3 planes) at 6 months. Hernia covered by Bio-A mesh (arrows).
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On CT scan, the mesh covered the previous defect (Figures 6(a)-6(c)) and no recurrent hernia developed.