Snapshot quiz 15/9

Published: 09/04/2015

Authors: Murtaza G, Vitone LJ and Monk D

The picture shows an interstitial hernia, causing small bowel obstruction. A 76-year-old woman with a history of previous total abdominal hysterectomy was admitted with symptoms and signs of small bowel obstruction. An emergency laparotomy was carried out and a large left-sided interstitial hernia containing distal jejunum was found. The small bowel was bruised but viable with an obvious transition point. A primary suture repair of the interstitial hernia was performed with complete obliteration of the interstitial space.

An interstitial hernia is a rare type of hernia that passes between the layers of the abdominal wall. Classically, as shown here, an interstitial hernia passes through a defect in the transversus abdominus and internal oblique muscles, but not through the intact aponeurosis of the external oblique. These hernias may not present with an obvious lump and may go unrecognized. There should be a high index of suspicion in a patient with previous abdominal surgery presenting with symptoms and signs of small bowel obstruction. Meticulous closure of the abdominal wall at the time ofinitial surgery remains the best way of avoiding interstitial hernia formation.