PMC6277219_01
Mass in the lower left abdomen.
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A tender mass measuring about 10 cm by 8 cm was present in the left iliac fossa region of the abdomen (Fig. 1).
Ultrasound showing the mass appearing cystic.
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Investigations done by the patient at the referring hospital included an abdomino-pelvic Ultrasound scan which revealed a cystic mass of about 45mls volume suggestive of mesenteric hematoma (Fig. 2) and a computed tomography (CT) scan which was suggestive of an obstructed spigelian hernia with the sac containing a small bowel loop and mesentery (Fig. 3).
Spigelian hernal sac.
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Under general anaesthesia, a transverse left lower abdominal incision was made and findings were herniation through a facial defect of about 5 cm by 4 cm along the lateral border of the rectus sheath (Fig. 4).
Strangulated segment of ileum.
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Hernia sac contained sero-sanguineous peritoneal fluid, gangrenous ileal segment (Fig. 5) and part of herniated urinary bladder forming the lower wall of the sac (Fig. 6).
Nylon darn.
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In addition, nylon darning from inguinal ligament to the rectus sheath was also done (Fig. 7).
Closure of the external oblique aponeurosis.
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Then closure of external oblique aponeurosis. (Fig. 8).