42 y/o male presents with pain, swelling and some redness at his umbilicus.
Answer: incarcerated umbilical hernia, with some signs of early strangulation
This ultrasound demonstrates a clear peritoneal defect with a loop of bowel penetrating through the defect. There does appear to be free fluid surrounding the loop of bowel. Although there is some blood flow present on color power doppler, peristalsis is absent in the incarcerated loop of bowel.
Bedside ultrasound has been shown to be useful in the diagnosis and confirmation of reduction of abdominal wall hernias.1,2,3
Although published data for umbilical hernias is sparse, sonographic sensitivity has been reported to be 96.6%, specificity of 84.8%, and positive predictive value of 92.6%.4
Signs suggestive of strangulation on bedside ultrasound are: lack of peristalsis in the incarcerated segment, thickened wall (> 3mm), free fluid around the segment, and lack of blood flow on color power doppler.
Based on this scan, the patient was taken to the operating room for definitive surgical management and repair of peritoneal defect.
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Blaivas M. Ultrasound-guided reduction of a Spigelian hernia in a difficult case: an unusual use of bedside emergency ultrasonography. Am J Emerg Med. 2002;20:(1)59-61. [pubmed]
Weng TI, Wang HP, Chen WJ, Chin LB, Ng LM. Ultrasound diagnosis of occult femoral hernia presenting with intestinal obstruction. Am J Emerg Med. 2001;19:(4)333-4. [pubmed]
Robinson A, Light D, Nice C. Meta-analysis of sonography in the diagnosis of inguinal hernias. J Ultrasound Med. 2013;32:(2)339-46. [PDF]