Computed Tomographic Appearance of Internal Herniation Through the Sigmoid Mesocolon

Abstract

The case of a patient with surgically proven internal herniation of a loop of ileum through the sigmoid mesocolon is described. This 66-year-old man presented clinically with acute lower abdominal pain and an elevated white blood cell count. A computed tomography (CT) scan showed a thickened bowel loop with "bird-beak" appearance in the pelvis, centered towards the medial side and lying aside the effaced sigmoid colon. We think this CT picture is highly suggestive of internal herniation of the ileum through the sigmoid mesocolon, which is a rare clinical entity.

An unusual case of transverse mesocolic internal hernia with abnormality of both hands and high arched feet

“…All of the aforementioned, abnormal hernias lack a sac and are “internal prolapses”. 5 Transmesenteric hernias have been described after surgical procedures such as gastric bypass surgery in which a Roux-en-Y loop is constructed that predisposes the development of internal hernia. 2…”

“…Internal hernia is a rare cause of small bowel obstruction with a reported incidence of 0.2–0.9%. 1–5 It leads to 0.5–4.1% of the cases of acute intestinal obstruction caused by hernias. 2 It may be either congenital or acquired.…”

Laparoscopic management of small bowel obstruction caused by a Sigmoid Mesocolic hernia

“…It has been suggested that such a bird-beak appearance in the pelvis that is centred towards the medial side in a patient with intestinal obstruction is highly suggestive of an MSH. [9] Nevertheless, in a majority of patients, the diagnosis of MSH is likely to be established only at surgery.…”