Internal hernias in children: spectrum of clinical and imaging findings

Abstract

There is a wide spectrum of clinical and imaging findings of IH in children. TMIH were difficult to appreciate on GI contrast examinations, but paraduodenal hernias were easy to appreciate. One must have a high index of suspicion for right paraduodenal hernia if UGI series shows duodenum and proximal small bowel to the right of the spine.

Mesenteric Defect with Internal Herniation: A Rare Cause of Bowel Obstruction in Newborn

“…Furthermore, the risk of volvulus and bowel ischemia is higher than other types of internal hernias [1,3]. In our case, a good prognostic was partly explained by isolated transmesenteric hernia without the start of enteral feeding.…”

“…In all reported neonate cases, bowel obstruction with internal herniation presented clinically with acute abdominal distension and persistent bilious or nonbilious vomiting after starting enteral feeding [1,2]. In our case, enteral feeding was not started because of severe respiratory distress, initially altered hemodynamic state and persistent moderate abdominal distention.…”

“…However, they appear to have a limited role in assisting the diagnosis of this disease. An upper gastrointestinal series (UGI) with small bowel follow through (SBFT) and contrast enema are the most useful imaging modalities in children but the detection ratio remains low [1,2]. In one case of transmesenteric congenital hernia reported by Tang et al, contrast enema in a one-dayold female newborn who presented with bilious vomiting and abdominal distension demonstrated a cluster of small ileal loops in the right flank and a dilated proximal ileum not filled with contrast [1].…”

“…Internal hernia is a very rare cause, mostly caused by congenital mesenteric defect in this age period [1]. Only nine cases have been reported in the literature over the past 20 years.…”

Neonatal obstructed Treitz’s hernia with abdominal cocoon simulating volvulus neonatorum

“…One must have a high index of suspicion for right paraduodenal hernia if the upper gastrointestinal series shows the duodenum and proximal small bowel to the right of the spine 6. In neonates, plain film provides very good background negative contrast of air and although based on features of haustra it is difficult to identify the large bowel but the contrast of air in stomach and duodenum and colon and rectum is darker as compared with small bowel (figure 1).…”