Abdominal eventration with massive visceral content

A 90 year old woman comes to the emergency department suffering abdominal pain and vomiting for 12 h.

Physical examination reveals a big abdominal herniation at the left side of the abdomen. It is painful, soft but not reducible, and not bigger than the previous days.

Abdominal X-ray reveals signs of incomplete small bowel obstruction: modest dilatation of loops and hydro-aerial levels, with no free gas on rectal ampoule.

Abdominal CT scan (Figs. 1 and 2) describes abdominal rectum diastases, which contains four digestive system organs: peripheral portion of third segment of the liver, gastric body, duodenum, and transverse and descendent colon.

Figure 1

Figure 2