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Fig. 21 | Insights into Imaging

Fig. 21

From: Imaging of thoracic hernias: types and complications

Fig. 21

a, b An 86-year-old male with history of (h/o) melanoma, now presenting with chronic right upper abdominal pain. Coronal contrast CT (a) identifies a right retrosternal diaphragmatic hernia. Note the narrow neck of the hernia sac with herniation of the stomach (body, pylorus and antrum), colon and omentum into the mediastinum. This is an incarcerated hernia. The patient was offered elective repair, which was declined. The same patient presented with new onset of acute right upper quadrant pain after 2 months. Coronal contrast-enhanced CT (b) demonstrates severe dilation of the stomach with gastric outlet obstruction (Movie 4). The herniated hepatic flexure is not dilated. Adhesions within the hernia sac can lead to bowel obstruction and narrowing. These require urgent decompression of the distended stomach by placement of a gastric tube followed by surgical repair

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