Transmesenteric internal hernia

Case contributed by Dr Nolan Walker


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

Patient Data

Age: 64
Gender: Female

CT abdomen and pelvis portal phase

There is a transmesenteric internal hernia.

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

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

The small bowel is situated anterior to the cecum, 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

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 cecum 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.

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Case information

rID: 51170
Published: 27th Feb 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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