Emergency #8 – Long case

83-year-old man with:
* Painful swelling in the right groin
* No fever
* Nausea but no vomiting, difficulty passing stools
* Swelling not reducible

What do you see? Is it an incarcerated inguinal hernia?

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Imaging findings

* Right-sided inguinal hernia with intestines inside
* Mechanical small bowel obstruction proximal of hernia
* Normal enhancement of the bowel wall

No signs of ischemia.

Differential diagnosis

Mechanical small bowel obstruction: Adhesions/bands–volvulus–internal hernia–obstructing tumour/tumoural implants–other hernia’s–congenital or acquired stenosis

Groin swelling: Adenopathy–femoral hernia–psoas abscess–retracted testicle

Management

If no signs of ischemia are present:
* Careful manual reduction attempt
* If not successful: emergency surgery (risk of strangulation)

If signs of ischemia are present:
* Emergency surgery

Key points

Incarceration only means the hernia is not reducible and does not say anything about the content. An incarcerated inguinal hernia can also contain abdominal fat without bowel loops

Incarcerated hernia can turn into strangulated hernia and lead to small bowel obstruction

Carefully inspect the enhancement of the implicated loop of small bowel

Lack of enhancement is an early sign of ischemia (strangulation) and an indication for urgent surgery

Get free registration for ECR 2019!

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EDiR: Question of the day: #3

We dare you to solve one of the hardest questions of the EDiR examination!
The European Board of Radiology raffles amongst the winners an examination place for the EDiR that will take place at the ECR 2019.
The registration for the ECR 2019 is also included!

73-year-old male. Referred for macroscopic haematuria. He was taking anticoagulants and there were stones in the right kidney. Axial US image of the bladder was performed. Which of the following could cause the appearance seen on these images?

Please, click here to enter your answer. Solve the question before 13:30.

Winner will be announced here, on the EBR blog, at 14:00.

Good luck!

EDiR: Question of the day: #2

We dare you to solve one of the hardest questions of the EDiR examination!
The European Board of Radiology raffles amongst the winners an examination place for the EDiR that will take place at the ECR 2019.
The registration for the ECR 2019 is also included!

Regarding SAPHO (synovitis, acne, postulosis, hyperostosis and osteitis) syndrome: Which of the following statements are correct?

Please, click here to enter your answer. Solve the question before 13:30.

Winner will be announced here, on the EBR blog, at 14:00.

Good luck!

EDiR Question of the day: #1

We dare you to solve one of the hardest questions of the EDiR examination!
The European Board of Radiology raffles amongst the winners an examination place for the EDiR that will take place at the ECR 2019.
The registration for the ECR 2019 is also included!

Regarding coronary anomalies: Which of the following statements are correct?

Please, click here to enter your answer. Solve the question before 13:30.

Winner will be announced here, on the EBR blog, at 14:00.

Good luck!