Right paraduodenal (internal) hernia with intestinal obstruction

Case contributed by Dr Gaurav Som Prakash Gupta

Presentation

Acute pain abdomen. Mild guarding and mild vomiting and pain abdomen. TLC mildly increased.

Patient Data

Age: 25
Gender: Male

Multiphase CECT of abdomen without oral contrast.

Modality: CT

Dilated small bowel loops (up to 3.8 cm in diameter). Looks like an internal hernia (?right paraduodenal hernia through ? Waldeyer's ring). Although the lateral portion of the third of duodenum is not seen, however no other definite signs of bowel non rotation noted. The relation of the SMA and the SMV appears to be maintained. The hernial sac is also showing significant amount of fluid. Clinical Data: Appendicitis.
 
Dilated small bowel loops are noted (measuring up to 3. 8 cm).

Although the lateral portion of the third part of the duodenum is not seen, however no other definite signs of bowel mal-rotation noted. The relation of the SMA and the SMV appears to be maintained.
The small bowel loops appears to be herniating in posterior and right lateral direction resulting in alteration of the course of the SMA. The hernial sac is displacing the SMA  which is seen lying anterior to the hernia sac. The artery is then looping and turning posteriorly and subsequently supplying the herniated bowel loops by branches that are now running posteriorly and towards right. 

Significant amount of fluid noted in hernial sac. However, the wall of the herniated loops appears to be enhancing at present. Fluid also seen in pericaecal and retrocolic region along ascending colon. Appendix not clearly defined. ICJ is normal. Terminal ileum is stretched but normal. 

Features are consistent with Right paraduodenal internal hernia with small bowel intestinal
obstruction. 

Findings confirmed surgically.

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Case Information

rID: 27770
Case created: 19th Feb 2014
Last edited: 21st Nov 2016
Tag: hernia
Inclusion in quiz mode: Included

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