Presentation
Mild epigastric pain. On ultrasound perihepatic fluid. Not possible to see any other structures due to gas interposition.
Patient Data
Internal pericecal hernia, containing both terminal ileum and right colon and proximal portion of transverse colon. The colonic loops are dilated and with adjacent fluid, radiological findings that raise the possibility of intestinal distress due to closed loop occlusion. No areas of wall hypoenhancement suggesting mural necrosis are currently observed.
This hernial content is located in the right paracolic gutter and in front of the liver (on which it exerts a mass effect). This location explains the absence of an adequate ultrasound window.
The rest of the intestinal loops are unaltered. Only minimal thickening of the submucosa in an 8 cm segment of the sigma stands out, of unspecific characteristics and without dilatation of retrograde loops.
Known hiatal hernia. Rest of the study without findings of significance.
Conclusion:
Internal pericecal hernia, containing terminal ileum and right colon; with closed loop occlusion and adjacent fluid. No signs suggesting mural necrosis.
Case Discussion
Emergency surgery was performed. Intraoperative findings confirmed internal hernia with closed loop occlusion. At the moment of the surgery, there were incipient signs of bowel wall ischemia, so right colectomy was performed.
Mild abdominal discomfort in old population is quite common in the Emergency Room. In this case, an early suspicion of intestinal ischemia led to a CT scan and to an early surgical procedure, with good outcome to the patient.
Pericecal hernia is a rare subtype of internal hernia (6-13% of all internal hernias).
The characteristic finding is the existence of cluster of bowel loops (usually ileal) located posteriorly and laterally to the normal cecum. Extension into the right paracolic gutter is common.