Small bowel obstruction due to pericaecal internal hernia
Severe abdominal pain with distension and vomitting. No past history of abdominal surgery.
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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 cecum in right paracolic gutter. These collapsed loops pass through a narrow neck (arrows) being the hernial orifice.
Pericaecal hernias account for 13% of all internal hernias. The pericaecal fossa is located behind the cecum and ascending colon, and is limited by the parietocecal fold outward and the mesentericocecal fold inward. Although there are four subtypes of hernia (ileocolic, retrocecal, ileocecal, and paracaecal), the most common is a herniated ileal segment protruding through a defect in the cecal mesentery extending into the right paracolic gutter as in this case.
- Jang EJ, Cho SH, Kim DD. A case of small bowel obstruction due to a paracecal hernia. J Korean Soc Coloproctol. 01;27 (1): 41-3. doi:10.3393/jksc.2011.27.1.41 - Free text at pubmed - Pubmed citation
- Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186 (3): 703-17. doi:10.2214/AJR.05.0644 - Pubmed citation