Presentation
Severe abdominal pain with vomiting. History of laparoscopic cholecystectomy and right mastectomy for breast carcinoma 3 days ago.
Patient Data
A few mildly dilated bowel loops with air-fluid levels in the upper central abdomen and paucity of gas in the distal abdomen. No pneumoperitoneum is seen. Surgical clips related to the cholecystectomy and right mastectomy are seen in place. A surgical drain is seen projecting over the right lower chest.
status post cholecystectomy and right mastectomy
small hernia (defect measuring 22 mm) in the midline anterior abdominal wall adjacent to the umbilicus, at the site of previous laparoscopic port. Herniation of a small bowel loop (distal ileum) with diffuse dilatation of the proximal small bowel and collapse of the distal bowel with a transition point within the hernial defect
minimal free fluid around the liver and in the pelvic cavity, likely postoperative in nature. No free air is seen in the abdomen and pelvis
simple left renal cortical cysts (Bosniak I) and right malrotated kidney
Case Discussion
CT scan findings and history of laparoscopic cholecystectomy are consistent with port site hernia with small bowel obstruction. The patient underwent an uneventful repair of this hernia.
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