Complicated abdominal wall hernia mimicking an abdominal wall abscess: A case report

Abstract

Abdominal wall hernias are a common imaging finding. Their most common complications include bowel obstruction, incarceration, strangulation and trauma. We report an exceptional case of spigelian hernia in 55 years old women complicated by perforation and massive subcutaneous emphysema which was correctly diagnosed by CT scan. This case showed the interest of CT scan with multiplanar reconstructions in the confirmation of the diagnosis.

Keywords: CT scan; Hernia; Perforation.

Fig. 1

(A, B and C) – Axial contrast material enhanced reformatted CT images of the abdomen showed an abdominal wall defect measuring 2 cm with herniated bowel loops in the left anterior abdominal region (white thick arrow). Associated stranding of herniated fat is also seen. Note the bowel wall thickening with pneumatosis intestinalis (thin arrow) and normal mural enhancement of herniated bowel (similar to that of intraabdominal bowel loops).

Fig. 2

Sagittal (D) and Coronal (E) unenhanced reformatted CT image better depicts abdominal wall defect (white arrow).

Fig. 3

(F) – Axial contrast material enhanced reformatted CT image of the abdomen shows dilatation of intraabdominal bowel loops secondary to rectal cancer recurrence (Red arrow. (G) Axial Ct scan image of the chest, lung window, shows: Massive subcutaneous emphysema dissecting into the deeper soft tissue and musculature of the left hemibody (white arrow), extending to the mediastinum (black arrow). We also notice a secondary lung cancer(Color version of the figure is available online.)