Transomental internal hernia leading to closed loop obstruction
Presentation
Abdominal pain.
Patient Data
Nondilated proximal-mid small bowel. Short segment mildly thickened and faecalized small bowel leading into an abrupt and narrowed transition point in the right lower quadrant leading into a cluster of mildly hypoenhancing fluid-filled small bowel loops with mesenteric edema and vessels radiating toward the narrowing. Second transition point immediately adjacent to the proximal as the terminal ileum leaves this cluster.
Case Discussion
This patient went to surgery where a transomental internal hernia was discovered containing distal small bowel - the surgery was described as "division of an omental ring that was causing an internal hernia".
Note that the coronal images are particularly helpful for understanding the configuration of the hernia with two adjacent transition points in the right lower quadrant (enter/exit the loop) and the clustered appearance of the bowel within the internal hernia with mesenteric edema and vessels radiating toward the hernia defect.
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