65 year old man with history of rectal cancer

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Razmin Aslani

Case Section

Urology&Genital Male Imaging

Patient's Information

Gender : Male
Age : 65

Clinical Summary

patient has history of rectal cancer

Imaging Findings

sagittal T2w and IR sequence and coronal T1w and IR sequence and axial T1w pelvic MRI shows fat containing tissue (omentum) which is herniated through bilateral inguinal canals.(indirect hernia)

Differential Diagnosis

LAP abscess sarcoma hernia

Final Diagnosis

bilateral indirect inguinal hernia

Discussion (Related Text)

Indirect Hernia - Consists of sac of peritoneum coming through internal ring, antero-medial to the spermatic cord (or round ligament) which omentum or bowel can enter. -Usually congenital, but may be acquired. -Virtually all hernias in patients under age 25 are indirect. -Male/female ratio is about 9:1. -Internal ring may be normal or dilated. -Higher risk of incarceration/strangulation if large and extends into scrotum.(1) A variety of external and internal abdominal hernias can cause bowel obstruction. Although cr is excellent for detecting and characterizing types of hernias and for demonstrating the bowel, mesentery, or omentum within a hernia sac,it is especially valuable in patients who have symptoms of small bowel obstruction, possibly resulting from hernia, but who have no hernia apparent on physical examination.Incarceration usually occurs as a result of a narrow hernia ring, which leads to bowel obstruction and may cause strangulation of the hernia sac and its contents.Small bowel obstruction caused by internal hernia can be predicted when cr shows abnormal location of bowel loops, crowding of small bowel loops, and an unusual course of mesenteric vessels .Because the hernia may not be recognizable if it is reduced spontaneously, it is better to perform cr during symptomatic periods. Defects in the small bowel mesentery, usually through a small hernia ring, may show a high frequency of strangulation and intestinal gangrene.(2)

References

1-read at:http://www.med.umich.edu/medstudents/curres/m3/surg/InguinalHernia.html 2-John R.Haaga , CT and MRI of the whole body , fifth edition 2009 , page 1304.