Internal hernia with ischaemic jejunum

Case contributed by Dr Ian Bickle

Presentation

Acute abdominal pain of short duration. Previous unspecified abdominal surgery.

Patient Data

Age: 50
Gender: Male
Modality: CT

Proximal small bowel closed loop obstruction with ischaemic segment of jejunum due to an internal hernia.

Annotation of the closed loop obtruction from the internal hernia

Modality: Annotated image

The tight neck of the internal hernia (green line) showing (red arrows) the entry and exit loops resulting in a closed loop obstruction of the proximal jejenum.

The segment of contained jejunum is thickened and non enhancing in keeping with focal ischaemia.

Small amount of intraperitoneal free fluid. No perforation.

Histopathology

Gross: segment of small intestine measuring 25cm.  The entire thickness of the wall and mucosa is drak red in colour.

Microscopy: The small intestine shows infarction, necrosis and grangrene involving the full thickness of the intestinal wall. No vascular thrombosis.

Comment: Ischaemic necrosis of proximal jejunal loop

 

Case Discussion

Internal hernias are well described, but usually challenging to identify on CT without the help of the surgical retrospectoscope.

In this case a short segment of jejunum just distal to the DJ flexure is containing within a internal hernia, with a resultant closed loop obstruction.  A segment of ischaemic bowel results.

PlayAdd to Share

Case Information

rID: 28601
Case created: 2nd Apr 2014
Last edited: 12th Jan 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.