Ultrasonographic Diagnosis and Facilitated Reduction of an Abdominal Wall Hernia

A 44-year-old man presented to the emergency department with sudden sharp severe periumbilical pain and “bulging” that occurred on a cough while riding in an automobile. Physical exam revealed a firm tender ovoid 4-cm mass just inferolaterally to the left of the umbilicus. Bedside ultrasound with 7.5-MHz linear probe and power Doppler confirmed diagnostic suspicion of abdominal wall hernia without strangulation (Figures 1 and 2). Following intravenous morphine and application of a cold pack to the abdominal mass, closed manual reduction was undertaken with pressure applied via both fingers and transducer under real-time video (available as an online Data Supplement at http://www.blackwell-synergy.com/doi/suppl/10.1111/j.1553-2712.2008.00138.x/suppl_file/acem_138_sm_VideoClipS1.mpg). Almost immediately, the mass was felt and seen to reduce back into the peritoneal cavity. A residual small abdominal wall defect was evident (Figure 3). After a period of observation, during which he remained asymptomatic and stable, the patient was discharged home with a surgical referral.

Figure 1.  Transducer placement indicated by arrow.

Figure 2.  Resultant ultrasound still images.

Figure 3.  Postreduction residual abdominal wall defect (between short arrows). An intestinal loop or mesentery floats immediately deep (long arrow).