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An 83-year-old man with a longstanding incisional hernia presented to the ED with a 48-hour history of vomiting and constipation. His medical history included thrombotic stroke, congestive cardiac failure, hypertension, chronic obstructive pulmonary disease and large bowel resection.
The patient was tachypnoeic. All other observations were stable. Examination revealed a distended abdomen with a hernia protruding beneath a midline laparotomy scar. The superior portion of the hernia was reducible and the edges of the wide defect palpable. However, inferiorly there was a firm, irreducible tender knuckle of tissue. An abdominal radiograph was requested to aid diagnosis (figure 1).
Which signs can be observed in the …
Contributors All authors contributed either to the management of the patient and/or authorship of this manuscript, and have all given final approval for this manuscript for submission.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.