Abstract
Maydl's hernia is a rare type of incarcerated inguinal hernia in which the hernial sac contains a double loop of intestine. The intestine between the loops remains in the abdomen. In this ‘W’-shaped hernia, the intra-abdominal closed loop may become gangrenous, with the loops in the hernial sac remaining viable. A 58-year-old man was admitted to the emergency department with a painful non-reducible mass in his right inguinal region. A plain abdominal radiograph showed no fluid-air levels, but an infant-head-sized shade in the right groin was visualized. Based on a preoperative diagnosis of suspected incarcerated inguinal hernia, we operated under general anesthesia. Although we tried to relieve the incarceration laparoscopically, the small intestine remaining in the intraperitoneal cavity became necrotic. We converted to an open procedure and relieved the incarceration manually. The hernia contained portions of the cecum and ileum without necrotic change. Resection of the gangrenous ileum and anastomosis were performed. The inguinal hernia was repaired with a conventional anterior approach. Maydl's hernia should be suspected in patients with large incarcerated hernias. Manual reduction or surgery by the conventional anterior approach without intraperitoneal exploration is contraindicated, as these methods may result in non-viable bowel being left behind.
