Photo Rounds

Abdominal mass

J Fam Pract. 2012 March;61(3)

A 46-year-old man sought care at a clinic for an abdominal mass, fatigue, and shortness of breath. He was also feeling depressed. Examination of the patient revealed an anterior, midline, irregularly shaped mass measuring 14 x 20 in. The nontender mass was hollow to percussion and was not as prominent when the patient was supine.

What's your diagnosis?

 

An abdominal ultrasound revealed subcutaneous, peristalsing bowel loops consistent with a ventral hernia. A small amount of ascites was also found.

Four years earlier, this patient had had a prolonged hospitalization for severe cor pulmonale, during which he suffered a perforated cecum. He had multiple abdominal surgeries, including a right hemicolectomy. His postop course was complicated by multisystem organ failure and several nosocomial infections.

Treatment of a ventral hernia involves either an open or laparoscopic surgical correction, often with the placement of a supportive mesh. Repair of epigastric hernias is crucial even in asymptomatic patients due to the high rate of bowel incarceration.

This patient was referred to a hernia specialty clinic at a nationally recognized medical center.

Adapted from: Murdoch W, Morris PA. Photo Rounds: Irregularly shaped abdominal mass. J Fam Pract. 2011;60:227-228.

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