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  Vol. 142 No. 2, February 2007 TABLE OF CONTENTS
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Image of the Month—Diagnosis


Arch Surg. 2007;142(2):200.

Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Answer: Incarcerated Sigmoid Volvulus in a Right Inguinal Hernia

The patient underwent an exploratory laparotomy and right groin exploration to look for signs of obstruction due to the incarcerated right inguinal hernia. The incarcerated bowel in the hernia sac was found to be a redundant sigmoid colon that had volvulized. Despite incarceration lasting several days, as well as volvulization, the colon sustained serosal tears but was not gangrenous. Dissection of the groin revealed a significant amount of scar tissue and old mesh from prior hernia repairs. Both direct and indirect components to the hernia sac were discovered. The preperitoneal inguinal hernia was repaired and a sigmoid colectomy, with end colostomy and a Hartmann procedure, was performed.

Given that this patient already had a sigmoid volvulus, we elected to perform a sigmoid colectomy rather than risk another volvulus in the postoperative period. After performing the Hartmann procedure, we attempted to repair the inguinal hernia via a transabdominal approach. The patient . . . [Full Text of this Article]

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