Congenital internal hernia as a cause of small bowel obstruction: CT findings in 11 adult patients

Abstract

The aim of this study is to report the CT findings in patients proved to have congenital internal hernia (CIH) as a cause of small bowel obstruction (SBO). The CT scans of 11 patients (9 men and 2 women, with ages ranging from 20 years to 95 years (mean 60.7 years), presenting with clinical symptoms and signs of SBO without previous abdominal surgery or trauma, were retrospectively reviewed. In all patients features of SBO were seen. In addition, in nine of them a saclike mass, containing dilated small bowel loops with mesenteric vessels converging toward its orifice was demonstrated and a pre-operative diagnosis of an incarcerated internal hernia was suggested. In the other two, a closed loop obstruction was seen without an identifiable cause. Mural thickening of the entrapped loops within the hernial sac was seen in five patients, with hypoperfusion in four of them, blurring of the mesenteric vessels with localized mesenteric fluid was demonstrated in seven and free peritoneal fluid in 10. All patients were operated on following the CT and an incarcerated CIH was confirmed. Gangrenous bowel was present at exploration in seven cases. One patient died. In conclusion, in patients with intact abdomen and SBO, CT may be the first imaging modality to discover a clinically unsuspected CIH, which requires prompt surgical intervention. Radiologists should be aware of the CT features suggestive of a SBO caused by CIH, i.e. a saclike mass of dilated small bowel loops, as a correct diagnosis will influence patient management and prognosis.

Transfalciform greater omental herniation

“…The distribution of internal hernias is paraduodenal (53%), pericaecal (13%), foramen of Winslow (8%), transmesenteric and transmesocolic (8%), intersigmoid (6%) and retroanastomotic (5%) 3. Hernias involving the falciform ligament are very rare, and while their true incidence is unknown, one study estimated it at 0.2% of internal hernias 2…”

A case of a paraduodenal hernia with a concomitant mesosigmoid defect

“…Acquired internal hernias can occur after any abdominal operation that involves resection or rearrangement of the gastrointestinal tract. The autopsy incidence of internal hernia is 0.2-2%, most of them asymptomatic and acquired [2] and they account for 0.6 to 5.8% of all cases of small bowel obstruction [3].…”

Hernia transmesentérica. Revisión del tema a raíz de un caso exótico de infarto intestinal en un adulto

“…Además del valor diagnóstico de la radiografía simple de abdomen, la tomografía abdominal computada (TAC) tiene sensibilidad y especificidad superiores al 90 % para el diagnóstico de obstrucción intestinal (94 % y 96 %, respectivamente). Sin embargo, para el diagnóstico de HI, la especificidad reportada es inferior al 80 % (43,44). Algunos hallazgos observados con frecuencia son: apelotonamiento de asas (87 %), ingurgitación (100 %) o torsión (65 %) de los vasos del mesenterio y neumatosis transmural, entre otros (45).…”