Internal hernia with bowel ischemia

Case contributed by Dr Vikas Shah

Presentation

Previous Roux-en-Y gastric bypass for weight loss. 1 day of abdominal pain. Tender across lower abdomen.

Patient Data

Age: 30 years
Gender: Female

CT abdomen and pelvis

CT

Gastrojejunal and jejunojejunal anastmoses are seen. There is a cluster of small bowel in the lower abdomen and pelvis with mesenteric congestion and stranding and free fluid. The loops aren't particularly dilated. Some of the loops don't enhance well. The remainder of the abdomen appears normal.

Case Discussion

The appearances suggest an internal hernia with congestion of the mesentery and altered enhancement of the bowel being due to ischemia. Internal herniae can be a cause of pain in patients following weight loss procedures due to mesenteric defects created during surgery. Signs of ischemia may be encountered in the absence of bowel obstruction.

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