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X-Ray Findings in A Large Ventral Hernia

X-Ray Findings in A Large Ventral Hernia X-Ray Findings in A Large Ventral Hernia J. E. Habbe , M.D. St. Vincent’s Hospital, Norfolk, Virginia Excerpt Because of the impossibility of their demonstration otherwise, short of operation or autopsy, diaphragmatic hernias furnish a not very rare field of study for the roentgenologist. Ventral hernias, on the other hand, are seldom referred for X-ray study, since the diagnosis by physical examination is usually quite easy. The case reported here is a good example of the facility with which roentgen diagnosis can still be carried out when hindrances to physical examination are wellnigh insurmountable. Mrs. A. S., aged 37, of Italian descent, whose weight was well over two hundred pounds despite a stature of only five feet three inches, had had a salpingo-oöphorectomy through a low midline incision in August, 1923, following which there was drainage through the wound for some weeks, the incision eventually closing over, however. Immediate post-operative recovery had been good, but in the past year the patient's weight had increased somewhat and for about six months there had been periods of right lower quadrant pain, associated with occasional nausea and vomiting. Constipation was severe. Physical examination revealed a well nourished, very obese patient, the condition being most marked on the anterior abdominal wall, where the fat sagged forward and downward like a short apron doubled back on itself. By physical examination it had been impossible to determine whether this “apron, ” which was bilateral although slightly more pendulous on the right side, was simply excess fat or a more definite herniation of abdominal contents within a peritoneal sac. X-ray findings . Fluoroscopic study of the stomach was practically valueless because of the obesity of the patient. Film examination made in the standing posterior-anterior and right lateral and in the prone posterior-anterior and right lateral positions revealed the stomach and duodenum grossly normal. The upper jejunum showed no displacement or other abnormality, but almost the entire ileum was herniated forward and downward and occupied a constant position, entirely in the right half of the anterior abdominal wall. The bowel loops appeared to lie no deeper than an inch beneath the skin in this region. There was no demonstrable marked narrowing of the space occupied by the barium-filled loops of bowel in the upper part of the hernia, hence this suggested a relatively large “neck” for the sac. At six hours the head of the meal was in the ascending colon. The herniated ileum was still well filled, and one or two loops showed apparent dilatation, suggesting relative constriction beyond. At twenty-four hours the head of the meal had reached the rectum. The small bowel was entirely empty of barium at this time but some gas-filled loops of bowel were still seen to lie within the sac. The transverse and descending colons contained almost no barium, but apparently there was no protrusion of this portion of the bowel into the hernia. Copyrighted by the Radiological Society of North America http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

X-Ray Findings in A Large Ventral Hernia

J. E. Habbe
Radiology , Volume 7 (6): 511 – Dec 1, 1926
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Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1926 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/7.6.511
Publisher site
See Article on Publisher Site

Abstract

X-Ray Findings in A Large Ventral Hernia J. E. Habbe , M.D. St. Vincent’s Hospital, Norfolk, Virginia Excerpt Because of the impossibility of their demonstration otherwise, short of operation or autopsy, diaphragmatic hernias furnish a not very rare field of study for the roentgenologist. Ventral hernias, on the other hand, are seldom referred for X-ray study, since the diagnosis by physical examination is usually quite easy. The case reported here is a good example of the facility with which roentgen diagnosis can still be carried out when hindrances to physical examination are wellnigh insurmountable. Mrs. A. S., aged 37, of Italian descent, whose weight was well over two hundred pounds despite a stature of only five feet three inches, had had a salpingo-oöphorectomy through a low midline incision in August, 1923, following which there was drainage through the wound for some weeks, the incision eventually closing over, however. Immediate post-operative recovery had been good, but in the past year the patient's weight had increased somewhat and for about six months there had been periods of right lower quadrant pain, associated with occasional nausea and vomiting. Constipation was severe. Physical examination revealed a well nourished, very obese patient, the condition being most marked on the anterior abdominal wall, where the fat sagged forward and downward like a short apron doubled back on itself. By physical examination it had been impossible to determine whether this “apron, ” which was bilateral although slightly more pendulous on the right side, was simply excess fat or a more definite herniation of abdominal contents within a peritoneal sac. X-ray findings . Fluoroscopic study of the stomach was practically valueless because of the obesity of the patient. Film examination made in the standing posterior-anterior and right lateral and in the prone posterior-anterior and right lateral positions revealed the stomach and duodenum grossly normal. The upper jejunum showed no displacement or other abnormality, but almost the entire ileum was herniated forward and downward and occupied a constant position, entirely in the right half of the anterior abdominal wall. The bowel loops appeared to lie no deeper than an inch beneath the skin in this region. There was no demonstrable marked narrowing of the space occupied by the barium-filled loops of bowel in the upper part of the hernia, hence this suggested a relatively large “neck” for the sac. At six hours the head of the meal was in the ascending colon. The herniated ileum was still well filled, and one or two loops showed apparent dilatation, suggesting relative constriction beyond. At twenty-four hours the head of the meal had reached the rectum. The small bowel was entirely empty of barium at this time but some gas-filled loops of bowel were still seen to lie within the sac. The transverse and descending colons contained almost no barium, but apparently there was no protrusion of this portion of the bowel into the hernia. Copyrighted by the Radiological Society of North America

Journal

Radiology – Radiological Society of North America, Inc.

Published: Dec 1, 1926

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