Transmesenteric internal hernia

Case contributed by Dr Nolan Walker

Presentation

Longstanding right sided abdominal pain. Outpatient. No previous surgery.

Patient Data

Age: 64
Gender: Female

CT abdomen and pelvis portal phase

Modality: CT

There is a transmesenteric internal hernia.

The ascending colon and caecum have herniated through a transmesenteric defect into the left iliac fossa.

The hernial orifice is situated immediately anterior to the aortic bifurcation.
The caecum is displacing the fourth part of the duodenum superiorly.

The small bowel is situated anterior to the caecum, in the left iliac fossa.

There is no fluid within the hernial sac to suggest incarceration or strangulation and there is no small or large bowel dilatation.

The SMV is enhancing normally.

Individual imaging slice anaylsis

Modality: CT

Some useful pointers to the diagnosis of an internal hernia are discussed in detail.

Case Discussion

This is a case of a transmesenteric internal hernia.

There is no strangulation at present.

Signs of strangulation include: bowel wall thickening in side the hernial sac, lack of SMV enhancement, fluid in the hernial sac and fat stranding in the herniated bowel mesentery.

There is no malrotation.

Internal hernias can be overlooked if the large bowel is not traced carefully.

A useful sign to alert the radiologist to a possible internal hernia, is seeing the caecum abnormally positioned, with the additional clue of seeing the small bowel surrounding the outside the large bowel (as illustrated).

There is no history of previous surgery to account for the mesenteric defect.

PlayAdd to Share

Case Information

rID: 51170
Case created: 6th Feb 2017
Last edited: 28th Feb 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.