PMC7509351_01
CT scan revealing a sac-like mass involving a dilated bowel loop (yellow dotted lines) descending anteriorly and laterally with respect to the bladder (B/white dotted line). Axial (A), sagittal (B) and coronal (C,D) sections.
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A right indirect herniation could be seen, but there was no bowel involvement and thus was not considered to be the cause of obstruction (Fig. 1).
Schematic illustration of port placement.
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A laparoscopy with a three-trocars technique (12 mm at navel and two 5 mm trocars at the bilateral abdominal flank) was performed (Fig. 2).
Intraoperative laparoscopic images showing incarcerated small bowel in a hernia sac located medial to the right medial umbilical fold (A). Incision of the peritoneal membrane began lateral to the sac (white arrow) and extended to the orifice, which allowed loosening and a safer incision of the orifice (yellow arrow). Incarcerated bowel shown by yellow dotted lines (B). View after reduction (C). The sac was partially resected (D).
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Upon inspection, a large bulging mass was seen medially to the right medial umbilical fold with incarceration of small bowel (Fig. 3A). With this wide incision, the orifice loosened allowing space for a precise incision of the orifice, and the bowel was reduced without injury (Fig. 3B). This revealed a hernia ring of approximately 2 cm x 2 cm (Fig. 3C). There was a concern of abscess formation since the sac contained inviable bowel, and so we chose to partially resect the sac to prevent fluid accumulation (Fig. 3D).