Clinical presentation
45 year old lady on Warfarin for recent left lower limb deep venous thrombosis. Previous ultrasound revealed a right ovarian cyst. So the patient came for a CT to assess both ovarian cyst and venous thrombosis status. Previous ultrasound and venous doppler revealed complete thrombosis of entire left lower limb extending proximally up to common iliac vein.
CT
i.v. iodinated contrast was administered followed by venous phase acquisition.
Findings
Anterior abdominal wall defect more than 2cm wide is seen at the umbilicus with herniation of omentum into a hernial sac confined to the abdominal wall. No bowel is seen traversing into the sac. Central filling defects are seen scattered along the left common iliac, external iliac and common femoral veins as a sequelae of the previous deep venous thrombosis, consistent with partial recanalization.
Discussion
An anterior abdominal wall defect is easily demonstrated in ultrasound, though at times quite overlooked when it is not the clinical question at hand. This was an incidental finding detected in an obese lady. While no ovarian cyst was detected, features of partial recanalization of left lower limb venous system was identified. The repeat lower limb venous doppler done for this lady reveal restoration of flow in the entire femoral, popliteal and calf veins with near total restoration of compressibility. The worries of any anterior abdominal hernia is the involvement of bowel or mesentery and secondary bowel obstruction, strangulation or incarceration. Rising intra abdominal pressure will further the hernia making it prone for bowel entry and incarceration.