Small bowel obstruction due to pericaecal internal hernia

Case contributed by Dr Chris O'Donnell

Presentation

Severe abdominal pain with distension and vomitting. No past history of abdominal surgery.

Patient Data

Age: 80
Gender: Female

Marked fluid-filled distension of small bowel loops extending into right iliac fossa where there is abrupt transition to collapsed small bowel with clustered ileal loops sitting posterior and lateral to the caecum in right paracolic gutter.  These collapsed loops pass through a narrow neck (arrows) being the hernial orifice.

Case Discussion

Pericaecal hernias account for 13% of all internal hernias. The pericaecal fossa is located behind the caecum and ascending colon, and is limited by the parietocaecal fold outward and the mesentericocaecal fold inward. Although there are four subtypes of hernia (ileocolic, retrocaecal, ileocaecal, and paracaecal), the most common is a herniated ileal segment protruding through a defect in the caecal mesentery extending into the right paracolic gutter as in this case.

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Case Information

rID: 34330
Case created: 15th Feb 2015
Last edited: 21st Nov 2015
Inclusion in quiz mode: Included

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