What is the diagnosis for a patient with a posterolateral abdominal wall hernia containing a knuckle of distal ileum and mesenteric fat, as seen on a Magnetic Resonance Imaging (MRI) scan of the abdomen?

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Last updated: May 29, 2025 • View editorial policy

Differential Diagnosis for Posterolateral Abdominal Wall Hernia

Single Most Likely Diagnosis

  • Incisional Hernia: The presence of a 4 cm defect in the posterolateral abdominal wall with herniation of mesenteric fat and a knuckle of distal ileum, along with evidence of prior surgery (surgically absent gallbladder and left kidney), suggests an incisional hernia as the most likely diagnosis. The chronic nature of the finding and the absence of bowel obstruction symptoms support this diagnosis.

Other Likely Diagnoses

  • Spigelian Hernia: Although less common, a Spigelian hernia could present with similar findings, especially given the location at the posterolateral aspect of the abdominal wall. However, the presence of a clear defect and the specific involvement of the distal ileum and mesenteric fat make incisional hernia more likely.
  • Lumbar Hernia: This type of hernia occurs through defects in the lumbar area and could potentially involve the kidney's position. However, the specific details provided do not strongly support this diagnosis over an incisional hernia.

Do Not Miss Diagnoses

  • Bowel Obstruction: Although the report mentions no evidence for bowel obstruction, this is a critical diagnosis not to miss due to its potential for severe complications, including ischemia and necrosis of the bowel. Continuous monitoring and follow-up are essential.
  • Incarcerated Hernia: An incarcerated hernia, where the herniated content becomes trapped, can lead to bowel obstruction or strangulation. The absence of symptoms does not rule out the potential for this complication, especially in a chronic setting.
  • Malignancy: Although rare, the possibility of a malignancy causing or being associated with the hernia should not be entirely dismissed, especially given the history of prior surgeries and the presence of scarring.

Rare Diagnoses

  • Congenital Diaphragmatic Hernia: This condition is typically diagnosed in infancy or early childhood but could potentially present later in life. However, the location and description provided do not support this as a likely diagnosis.
  • Traumatic Hernia: A hernia resulting from trauma could present similarly, but there's no mention of a traumatic event in the provided history, making this less likely.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.