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Yang HK, Rezende-Neto JB, Brasil VW, Colak E. Surgery-confirmed internal hernia with or without Roux-en-Y anastomosis: diagnostic performance of six CT signs. Abdom Radiol (NY) 2025:10.1007/s00261-025-04927-7. [PMID: 40208288 DOI: 10.1007/s00261-025-04927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 03/20/2025] [Accepted: 03/29/2025] [Indexed: 04/11/2025]
Abstract
PURPOSE To assess the diagnostic performance and generalizability of established CT signs of internal hernias across a broad patient population including those with and without Roux-en Y anastomosis. METHODS Our institutional review board approved this retrospective study. CT scans of 21 patients (11 women, 10 men) with surgically confirmed internal hernia and 52 control patients (23 women, 29 men) in whom internal hernia was suspected on CT but subsequently excluded surgically were reviewed. Six CT signs were evaluated: non-duodenal small bowel (ND-SB) behind the superior mesenteric artery (SMA), right-sided jejunojejunal anastomosis in applicable patients, "swirl" sign, superior mesenteric vein compression, "mushroom" sign, and clustered small bowel (SB) loops. Sensitivity, specificity, and odds ratios with 95% confidence intervals were calculated for each sign using logistic regression. RESULTS Logistic regression identified the "mushroom" sign, clustered SB, and ND-SB behind the SMA as significant independent predictors of internal hernia with an area under the receiver operating characteristic curve of 0.746. The sensitivity, specificity, and odds ratio of the "mushroom" sign, clustered SB, and ND-SB behind the SMA were 38.1%, 86.5%, 3.96 (95% CI, 1.21-12.97), 47.6%, 75.0%, 2.73 (95% CI, 0.94-7.89), and 33.3%, 88.2%, 3.75 (95% CI, 1.08-13.02), respectively. CONCLUSION The "mushroom" sign, clustered SB, and ND-SB behind the SMA are valuable CT findings in diagnosing internal hernias irrespective of Roux-en-Y anastomosis. In particular, ND-SB behind the SMA and the "mushroom" sign are highly specific.
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Affiliation(s)
- Hyun Kyung Yang
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of
| | - Joao Baptista Rezende-Neto
- Department of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Viviane Willig Brasil
- Department of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Errol Colak
- Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
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Wang XL, Jin GX, Xu JF, Chen ZR, Wu LM, Jiang ZL. Right paraduodenal hernia, classification, and selection of surgical methods: a case report and review of the literature. J Med Case Rep 2023; 17:536. [PMID: 38158564 PMCID: PMC10757357 DOI: 10.1186/s13256-023-04286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Considering that right paraduodenal hernia is a rare internal hernia with abnormal anatomy and is often encountered during an emergency, surgeons may lack knowledge about it and choose incorrect treatment. Thus, this case report is a helpful complement to the few previously reported cases of right paraduodenal hernia. Additionally, we reviewed all the reported right paraduodenal hernia cases and proposed appropriate surgical strategies according to different anatomical features. CASE PRESENTATION The case involved a 33-year-old Chinese male patient who was admitted to the hospital due to abdominal pain. The patient was initially diagnosed with small bowel obstruction, and conservative treatment failed. An emergency operation was arranged, during which a diagnosis of right paraduodenal hernia was made instead. After surgery, the patient recovered well without abdominal pain for 2 years. CONCLUSION Although right paraduodenal hernia accounts only for a small proportion of paraduodenal hernia, its anatomical characteristics can vary considerably. We divided right paraduodenal hernia into three types, with each type requiring a different surgical strategy.
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Affiliation(s)
- Xiao-Long Wang
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Gui-Xiu Jin
- Department of Gynecology and Obstetrics, Taixing People's Hospital, Taixing, Jiangsu, China
| | - Jian-Feng Xu
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China
| | - Zhi-Rong Chen
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China
| | - Li-Meng Wu
- Department of Radiology, Taixing People's Hospital, Taixing, Jiangsu, China
| | - Zhi-Long Jiang
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China.
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Muacevic A, Adler JR, Sandhu P, Singh H, Bansal A. Paraduodenal Hernia With Massive Intestinal Gangrene and Its Surgical Management: A Case Report. Cureus 2022; 14:e32008. [PMID: 36589185 PMCID: PMC9798460 DOI: 10.7759/cureus.32008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Paraduonenal hernia constitutes more than 50% of internal hernia cases. It can result in perilous sequelae like gut ischemia and perforation. We report a case of a patient who presented with acute intestinal obstruction and peritonitis and was diagnosed as a case of complicated paraduodenal as an incidental finding on laparotomy. A 26-year-old male patient presented with three days history of continuous severe incapacitating diffuse abdominal pain. The pain was associated with multiple episodes of bilious vomiting and absolute constipation. Patient had signs and symptoms of shock. Abdomen examination showed generalized peritonitis. Patient had deranged laboratory investigations. Abdominal X-ray showed acute intestinal obstruction. Patient was resuscitated and taken up for emergency laparotomy. Intraoperatively there was a long segment of gangrenous small bowel entrapped in the paraduodenal sac. Gangrenous gut was released from the sac and excised with proximal and distal ends fashioned as stoma through separate sites. Patient was managed with intravenous fluids with total parental nutrition. Patient gradually started on oral diet and jejunostomy output was refed through the distal stoma. Patient was discharged on postoperative day 14. Patient had uneventful early stoma closure at postoperative day 45 and now is on regular follow-up in the outdoor department. Paraduodenal hernias are one of the rare causes of intestinal obstruction that is difficult to diagnose. Radiologic investigation like abdominal computed tomography (CT) scan can aid in diagnosis of paraduodenal hernia. Surgeons should have clear knowledge about abnormal anatomy of internal hernias and complications they can face during surgery.
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Pakanati R, Prasad GV, Reddy BR, Swathi B. Left-sided mesocolic hernia presenting as internal Maydl's hernia, complicated by jejunal volvulus. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2019. [DOI: 10.4103/jdrntruhs.jdrntruhs_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Laparoscopic Repair of Right Paraduodenal Hernia in Adult Patients: Case Report and Literature Review. Case Rep Surg 2018; 2018:9691689. [PMID: 30410812 PMCID: PMC6205318 DOI: 10.1155/2018/9691689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022] Open
Abstract
A 56-year-old Japanese female presented with vomiting, nausea, and abdominal pain after excessive drinking and eating. Abdominal computed tomography showed an encapsulated circumscribed cluster of jejunal loops in the right upper quadrant. She was diagnosed with a strangulated intestinal obstruction caused by right paraduodenal hernia (PDH) and underwent an emergency laparoscopic repair. A view through the endoscope showed the right PDH, which was encapsulated under the mesocolon. Most of the small bowel was entrapped and adhered inside the sac, requiring careful adhesiolysis. The hernia orifice was expanded to a sufficient degree, and the strangulation was relieved, avoiding the need of resecting the small intestine. Recovery was uneventful, and the patient remains free of symptoms 3 years after surgery. Findings in a total of 29 patients (including this report) who underwent laparoscopic repair of right or left PDHs in Japan are discussed.
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MDCT signs predicting internal hernia and strangulation in patients presented to emergency department with acute small bowel obstruction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Doishita S, Takeshita T, Uchima Y, Kawasaki M, Shimono T, Yamashita A, Sugimoto M, Ninoi T, Shima H, Miki Y. Internal Hernias in the Era of Multidetector CT: Correlation of Imaging and Surgical Findings. Radiographics 2015; 36:88-106. [PMID: 26587890 DOI: 10.1148/rg.2016150113] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Clinical diagnosis of internal hernias is challenging because of their nonspecific signs and symptoms. Many types of internal hernias have been defined: paraduodenal, small bowel mesentery-related, greater omentum-related, lesser sac, transverse mesocolon-related, pericecal, sigmoid mesocolon-related, falciform ligament, pelvic internal, and Roux-en-Y anastomosis-related. An internal hernia is a surgical emergency that can develop into intestinal strangulation and ischemia. Accurate preoperative diagnosis is crucial for appropriate management. Multidetector computed tomography (CT), with its thin-section axial images, high-quality multiplanar reformations, and three-dimensional images, currently plays an essential role in preoperative diagnosis of internal hernias. The diagnostic approach to internal hernias at multidetector CT includes detecting an intestinal closed loop, identifying the hernia orifice, and analyzing abnormal displacement of surrounding structures and key vessels around the hernia orifice and hernia sac. At each step, multidetector CT can depict pathognomonic findings. A saclike appearance suggests an intestinal closed loop in several types of internal hernias. Convergence, engorgement, and twisting of mesenteric vessels in the hernia orifice can be seen clearly at multidetector CT, especially with use of multiplanar reformations. For definitive diagnosis of an internal hernia, analysis of displacement of anatomic landmarks around the hernia orifice is particularly important, and thin-section images provide the required information. Detailed knowledge of the anatomy, etiology, and imaging landmarks of the various hernia types is also necessary. Familiarity with the appearances of internal hernias at multidetector CT allows accurate and specific preoperative diagnosis. (©)RSNA, 2015.
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Affiliation(s)
- Satoshi Doishita
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Tohru Takeshita
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Yasutake Uchima
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Masayasu Kawasaki
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Taro Shimono
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Akiyoshi Yamashita
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Michiko Sugimoto
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Teruhisa Ninoi
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Hideki Shima
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Yukio Miki
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
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[Gangrenous appendicitis?]. Chirurg 2014; 85:711-3. [PMID: 24464337 DOI: 10.1007/s00104-013-2640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Torcivia A, Genser L, Siksik JM. Left paraduodenal hernia in an adult obese patient at the time of bariatric surgery. Surg Obes Relat Dis 2013; 9:e66-8. [PMID: 23453727 DOI: 10.1016/j.soard.2013.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/18/2013] [Accepted: 01/18/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Adriana Torcivia
- Department of Digestive and Hepato-Pancreato-Biliary Surgery Assistance, Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Pierre & Marie Curie University, Institute of Cardiology Metabolism and Nutrition (ICAN), Paris, France.
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Al-Khyatt W, Aggarwal S, Birchall J, Rowlands TE. Acute intestinal obstruction secondary to left paraduodenal hernia: a case report and literature review. World J Emerg Surg 2013; 8:5. [PMID: 23324390 PMCID: PMC3551681 DOI: 10.1186/1749-7922-8-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias. Methods A literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH). Results In Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18 – 82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH. Conclusion Intestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.
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Affiliation(s)
- Waleed Al-Khyatt
- Division of General Surgery and Radiology, Royal Derby Hospital, Uttoxetter Road, Derby DE22 3DT, UK.
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A rare presentation of midgut malrotation as an acute intestinal obstruction in an adult: Two case reports and literature review. Int J Surg Case Rep 2012; 4:72-5. [PMID: 23123419 DOI: 10.1016/j.ijscr.2012.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/13/2012] [Accepted: 10/05/2012] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Midgut malrotation is a congenital anomaly presenting mainly in the childhood. Its presentation as an acute intestinal obstruction is extremely rare in adults usually recognized intra-operatively, therefore a high index of suspicion is always required when dealing with any case of acute intestinal obstruction. PRESENTATION OF CASE We report two cases of young adults who presented with symptoms of acute intestinal obstruction and were diagnosed intra-operatively as cecal volvulus and paraduodenal hernia, respectively, caused by midgut malrotation. Post-operative CT scan confirmed these findings. DISCUSSION Malrotation of the intestinal tract is a product of an aberrant embryology. The presentation of intestinal malrotation in adults is rare (0.2-0.5%). Contrast enhanced CT can show the abnormal anatomic location of a right sided small bowel, a left-sided colon and an abnormal relationship of the superior mesenteric vein (SMV) situated to the left of the superior mesenteric artery (SMA) instead of to the right. CONCLUSION Anomalies like midgut malrotation can present as an operative surprise and awareness regarding these anomalies can help surgeons deal with these conditions.
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Lu CW, Liu LC. Right-side paraduodenal hernia: unexplained recurrent abdominal pain. Clin Imaging 2012; 36:68-71. [PMID: 22226447 DOI: 10.1016/j.clinimag.2011.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 04/20/2011] [Indexed: 10/14/2022]
Abstract
Paraduodenal hernia is a rare congenital malformation. Although it may be an incidental finding at autopsy or at laparotomy, some cases are symptomatic. In such a condition, imaging is mandatory for the diagnosis. In the clinical literature, only a few cases of paraduodenal hernia diagnosed with computed tomography (CT) have been reported. We report two cases of surgically proven right paraduodenal hernia diagnosed preoperatively by multislice helical CT.
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Affiliation(s)
- Chih-Wei Lu
- Department of Trauma and Emergency Surgery, China Medical University Hospital, China Medical University, No.2 Yuh-Der Road, Taichung, Taiwan, R.O.C
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Falk GA, Yurcisin BJ, Sell HS. Left paraduodenal hernia: case report and review of the literature. BMJ Case Rep 2010; 2010:2010/nov22_1/bcr0420102936. [PMID: 22797200 DOI: 10.1136/bcr.04.2010.2936] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Paraduodenal hernias are congenital internal hernias that usually present with non-specific symptoms, and are therefore rarely diagnosed preoperatively. Left-sided paraduodenal hernias are three times more likely to occur than right-sided ones. Both hernias present similarly, but have a differing embryological basis. Here, the case of a 76-year-old woman with a left paraduodenal hernia presenting with small bowel obstruction is presented, and a brief discussion of the literature on its diagnosis and management given.
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Affiliation(s)
- Gavin A Falk
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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14
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Virich G, Davies W. A massive left paraduodenal fossa hernia as an unusual cause of small bowel obstruction. Ann R Coll Surg Engl 2010; 92:W7-9. [PMID: 20500999 DOI: 10.1308/147870810x12659688851997] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia, containing over 30% of the small bowel, presenting with a history of recurrent incomplete small bowel obstruction.
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Affiliation(s)
- George Virich
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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Lin CH, Ho YJ, Lin WC. Preoperative Diagnosis of Right Paraduodenal Hernia by Multidetector Computed Tomography. J Formos Med Assoc 2008; 107:500-4. [DOI: 10.1016/s0929-6646(08)60159-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Treitz's hernia is the eponymous name for a paraduodenal hernia. These are rare hernias that arise in the potential spaces and folds of the posterior parietal peritoneum adjacent to the ligament of Treitz. Presentation may be acute with small bowel obstruction or bowel ischaemia, or with chronic intermittent abdominal pain. Treatment is by surgery, due to the high (50%) lifetime risk of obstruction. Here, we present two cases from our own institution and review the literature regarding the embryology, anatomy, cross-sectional imaging and surgery of these fascinating hernias.
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Tekin A, Aksoy F, Vatansev C, Kücükkartallar T. Rare cause of ileus in the mesenteric cavity of terminal ileum: A report of three cases. World J Gastroenterol 2006; 12:5422-3. [PMID: 16981284 PMCID: PMC4088221 DOI: 10.3748/wjg.v12.i33.5422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Internal herniation is one of the rare reasons of intestine clog, which is hard to diagnose and usually needs an urgent surgical treatment. We report 3 patients with internal herniation in the mesenteric cavity of the terminal ileum. Besides intestinal congestion, they also had peritoneal irritation. Laparotomy revealed that herniation caused disorder in nutrition of the intestine and necrosis. The patients underwent subtotal small intestine resection and were discharged 10, 12 and 14 d after operation.
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Affiliation(s)
- A Tekin
- Kilicarslan Mah. Rauf Denktas cad. Aybike Sit.A 2 Blok 87/11 Selcuklu- Konya, Turkey.
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Kurachi K, Nakamura T, Hayashi T, Asai Y, Kashiwabara T, Nakajima A, Suzuki S, Konno H. Left paraduodenal hernia in an adult complicated by ascending colon cancer: A case report. World J Gastroenterol 2006; 12:1795-7. [PMID: 16586557 PMCID: PMC4124363 DOI: 10.3748/wjg.v12.i11.1795] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Paraduodenal hernia is the most common internal hernia. The clinical symptoms of paraduodenal hernia may be intermittent and nonspecific. Therefore, it is difficult to diagnose preoperatively. Abdominal computed tomography (CT) scan currently plays an important role in the evaluation and management of paraduodenal hernia before surgical operation. We report one unique case of preoperatively diagnosed left paraduodenal hernia complicated by advanced ascending colon cancer and reviews of Japanese literature.
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Affiliation(s)
- Kiyotaka Kurachi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan.
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20
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Huang YM, Chou ASB, Wu YK, Wu CC, Lee MC, Chen HT, Chang YJ. Left paraduodenal hernia presenting as recurrent small bowel obstruction. World J Gastroenterol 2005; 11:6557-9. [PMID: 16425435 PMCID: PMC4355805 DOI: 10.3748/wjg.v11.i41.6557] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Internal herniation of the small bowel is a relatively rare cause of intestinal obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. We report our experience in the diagnosis and management of a young male with left paraduodenal hernia presenting as recurrent intestinal obstruction. Correct preoperative diagnosis of left paraduodenal hernia had been difficult due to non-specific clinical presentations, but the advent of modern imaging technology makes early and correct diagnosis possible. Due to the risk of obstruction and strangulation, surgical treatment is indicated; however, timely intervention increases the likelihood of a favorable outcome.
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Affiliation(s)
- Yu-Min Huang
- Department of Surgery, Buddhist Tzu-Chi General Hospital, No. 707, Sec. 3, Chung Yang Road, Hualien City, Hualien County 970, Taiwan, China.
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21
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Hong SS, Kim AY, Kim PN, Lee MG, Ha HK. Current Diagnostic Role of CT in Evaluating Internal Hernia. J Comput Assist Tomogr 2005; 29:604-9. [PMID: 16163028 DOI: 10.1097/01.rct.0000168326.17363.b2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transmesenteric hernia is frequently encountered in practice, and because of the high risk of strangulation, even small internal hernias are dangerous. Knowledge of the characteristic imaging features and the mechanism of internal hernia can lead to early detection and correct diagnosis, both of which can save the patient's life. This article describes common CT findings of internal hernia with emphasis on various postoperative transmesenteric hernias as well as other common internal hernias.
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Affiliation(s)
- Seong Sook Hong
- Department of Radiology, Soonchunhyang University Hospital, Seoul, South Korea
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22
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Abstract
A 3-year-old girl presented with a protein-losing enteropathy caused by left paraduodenal hernia, as diagnosed by computed tomography and a small-bowel follow-through image. The patient received surgical treatment, and her postoperative course was uneventful. Nineteen days later, the serum protein and albumin had recovered to normal levels. As well as providing the first description of left paraduodenal hernia accompanied with protein-losing enteropathy, we also review the pertinent literature.
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Affiliation(s)
- Takahisa Tainaka
- Department of Pediatric Surgery, Aichi Children's Health and Medical Center, Aichi 474-0031, Japan.
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23
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Osadchy A, Weisenberg N, Wiener Y, Shapiro-Feinberg M, Zissin R. Small bowel obstruction related to left-side paraduodenal hernia: CT findings. ACTA ACUST UNITED AC 2004; 30:53-5. [PMID: 15647871 DOI: 10.1007/s00261-004-0248-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Accepted: 04/07/2004] [Indexed: 02/07/2023]
Abstract
The role of computed tomography in the evaluation of patients with small bowel obstruction has been extensively described in the current literature. We report a rare case of small bowel obstruction related to a surgically proved left-side paraduodenal hernia detected on abdominal computed tomography.
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Affiliation(s)
- A Osadchy
- Department of Diagnostic Imaging, Meir Hospital, Sapir Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Kfar Saba 44281, Israel.
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24
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Taourel P, Baud C, Lesnik A, Le Guen V, Pujol J, Bruel JM. Le péritoine acteur de la pathologie abdominale. ACTA ACUST UNITED AC 2004; 85:574-90. [PMID: 15184805 DOI: 10.1016/s0221-0363(04)97632-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The peritoneum is an important actor in diseases of the abdomen: defects of the peritoneum or mesos may lead to internal hernias; developmental anomalies of the peritoneum may lead to volvulus and bowel obstruction; diffuse or localized primary or secondary tumors of the peritoneum may develop; infectious, inflammatory or ischemic primary diseases of the peritoneum may cause abdominal pain, sepsis or result in the formation of fluid collections. The purpose of this presentation is to illustrate the role of imaging in the diagnosis of these different diseases and to provide some guidelines allowing their detection and characterization.
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Affiliation(s)
- P Taourel
- Service d'Imagerie Médicale, Hôpital Lapeyronie, CHU Montpellier, 371, avenue du Doyen-Giraud, 34295 Montpellier 05.
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25
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Moran JM, Salas J, Sanjuán S, Amaya JL, Rincón P, Serrano A, Tallo EM. Paramesocolic hernias: consequences of delayed diagnosis. Report of three new cases. J Pediatr Surg 2004; 39:112-6. [PMID: 14694386 DOI: 10.1016/j.jpedsurg.2003.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND If internal hernias account for less than 1% of the causes of intestinal obstruction, the paraduodenal or paramesocolic hernias (PMH) represent 50% of the 500 published as of the year 2000. Despite their congenital character, they are diagnosed more frequently in adulthood, with a mean age of 38 years at diagnosis. In the last few years, diagnoses are being made earlier. With the goal of increased early diagnosis and decreased mortality associated with these internal hernias, the authors report on 3 young patients with PMH. METHODS Three cases of paramesocolic hernias are reported, 2 right (RPMH) and 1 left (LPMH). They all had a history of symptoms of recurrent abdominal pain of variable frequency and intensity but of sufficient importance to justify previous diagnostic studies. The 2 patients with RPMH, a 3-year-old boy and a 17-year-old woman, presented symptoms of intestinal obstruction and had necrosis of the small intestine leading to short-bowel syndrome. The LPMH patient, a 13-year-old boy, suffered recurrent abdominal pain from the age of 3. Gastroesophageal reflux was diagnosed, and surgery was performed at the age of 4 years. A laparoscopy at 13 years of age found no pathology. A new upper gastrointestinal tract series found retroperitoneal and paraduodenal jejunum incarceration, partially obstructing the duodenum. During surgery, the adhered jejunal section was restored intraperitoneally, and the open Treitz arch was closed. The authors have not found the anatomic characteristics of this case in the literature. CONCLUSIONS Delays and errors in PMH diagnosis may result in irreparable damage. Differential diagnosis workups of patients with recurrent abdominal pain syndrome should always include PMH.
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Affiliation(s)
- Jose M Moran
- University Department of Surgery and Pediatric Surgery, Faculty of Medicine, University Hospital Infanta Cristina, University of Extremadura, Badajoz, Spain
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26
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Tsushima Y, Kato K, Endo K. Abdominal pain and vomiting after gynaecological surgery. Br J Radiol 2002; 75:783-4. [PMID: 12200250 DOI: 10.1259/bjr.75.897.750783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Y Tsushima
- Department of Radiology, Motojima General Hospital, 3-8 Nishi-Honcho, Ohta, Gunma 373-0033, Japan
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27
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Blachar A, Federle MP. Internal hernia: an increasingly common cause of small bowel obstruction. Semin Ultrasound CT MR 2002; 23:174-83. [PMID: 11996230 DOI: 10.1016/s0887-2171(02)90003-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Internal hernia is an uncommon cause of small bowel obstruction that may be increasing in frequency. Because the clinical diagnosis of internal hernia is difficult, imaging studies such as computed tomography (CT) and small bowel follow through play an important role. Transmesenteric hernia is the most common type and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis (eg, liver transplantation, gastric bypass). CT may allow confident diagnosis in most cases. In this article, we review the clinical and imaging findings of internal hernia based on our experience with 54 cases of surgically proven internal hernias including 45 transmesenteric, 6 paraduodenal, and 3 omental hernias, 39 of which had imaging studies available for review.
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Affiliation(s)
- Arye Blachar
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
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28
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Hernia paraduodenal derecha oclusiva. Diagnóstico por TC. RADIOLOGIA 2002. [DOI: 10.1016/s0033-8338(02)77796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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29
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Affiliation(s)
- Raymond S K Tong
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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30
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Blachar A, Federle MP, Brancatelli G, Peterson MS, Oliver JH, Li W. Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology 2001; 221:422-8. [PMID: 11687686 DOI: 10.1148/radiol.2212010126] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the performance of radiologists in the diagnosis of internal hernia with specific computed tomographic (CT) findings. MATERIALS AND METHODS Abdominal CT scans obtained in 42 patients were retrospectively reviewed by three radiologists. The case group consisted of 18 patients with internal hernias (two paraduodenal, 16 transmesenteric); the comparison group was 24 patients with no internal hernia. Images were reviewed in a random and blinded fashion. Individual and group performance was evaluated with receiver operating characteristic (ROC) analysis, and interobserver agreement was measured with Cronbach coefficient alpha. Individual CT signs relevant as predictors of transmesenteric hernia were identified with logistic regression analysis and ranked by their odds ratio and P values. RESULTS Both paraduodenal hernias were diagnosed by all readers on the basis of CT signs, including a retrogastric saclike mass of small-bowel loops. Diagnosis of transmesenteric hernia was more difficult and variable, with an average accuracy of area under the ROC curve (A(z)) of 77%, sensitivity of 63%, and specificity of 76%. CT signs of transmesenteric hernia were recognized consistently (Cronbach coefficient alpha >or= 0.80) and included a cluster of dilated small-bowel segments and stretching and displacement of mesenteric vessels. Coexisting volvulus and ischemia were diagnosed with low sensitivity (46% and 43%, respectively) but high specificity (96% and 98%, respectively). CONCLUSION Diagnosis of internal hernia with CT remains difficult. Special attention should be given to the clustering of bowel loops, the mesenteric vessels, and signs of small-bowel obstruction.
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Affiliation(s)
- A Blachar
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Rm 4660 CHP MT, Pittsburgh, PA 15213-2582, USA
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31
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Okino Y, Kiyosue H, Mori H, Komatsu E, Matsumoto S, Yamada Y, Suzuki K, Tomonari K. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiographics 2001; 21:1475-90. [PMID: 11706218 DOI: 10.1148/radiographics.21.6.g01nv121475] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The root of the small-bowel mesentery (SBM) is an important peritoneal fold that is contiguous to other peritoneal ligaments and mesocolons. Several pathologic conditions can occur in the SBM itself, and diseases that spread through the connections from adjacent organs frequently involve it. The root of the SBM is contiguous to the hepatoduodenal ligament around the superior mesenteric vein (SMV) and contiguous to the right side of the transverse mesocolon around the gastrocolic trunk. The inferior mesenteric vein, which is a landmark of the descending mesocolon, runs along the left side of the root of the SBM. Malignant neoplasms can spread to the SBM by means of direct extension, extension along the neural plexus, extension along neighboring ligaments, or extension along lymphatic vessels. Inflammatory conditions such as pancreatitis and perforation of a jejunal diverticulum can also spread to the SBM. Anomalies that can occur in the SBM include rotation anomalies and internal hernia. Vascular lesions of the SBM include thrombosis of the superior mesenteric artery (SMA), acute SMV thrombosis, SMA dissection, arterioportal fistula, and portal venous gas. Other pathologic conditions that can occur in the SBM are edema or congestion, mesenteric tear, mesenteric panniculitis, and tumors or tumorlike lesions.
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Affiliation(s)
- Y Okino
- Department of Radiology, Oita Medical University, Hasama-machi, Oita 879-5593, Japan.
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32
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Dritsas ER, Ruiz OR, Kennedy GM, Blackford J, Hasl D. Paraduodenal Hernia: A Report of Two Cases. Am Surg 2001. [DOI: 10.1177/000313480106700803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Paraduodenal hernias are uncommon congenital herniations into the mesentery of the colon that present as small bowel obstruction. The diagnosis is elusive but may be made by CT scan or upper gastrointestinal series. There are three types: left, right, and transverse. The repair involves reduction of the hernia and closure of the mesenteric defect in accordance with the anatomy of the hernia. We present two cases of paraduodenal hernia that are representative of this unusual class of internal herniation.
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33
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Blachar A, Federle MP, Dodson SF. Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology 2001; 218:68-74. [PMID: 11152781 DOI: 10.1148/radiology.218.1.r01ja5368] [Citation(s) in RCA: 211] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis. MATERIALS AND METHODS Retrospective review of medical records revealed 17 patients with surgically proved internal hernia (three paraduodenal, 14 transmesenteric) who had 15 computed tomographic (CT) scans and three small-bowel follow-through (SBFT) images. RESULTS CT signs common to all types of internal hernia included evidence of small-bowel obstruction; clustering of small bowel; stretched, displaced, crowded, and engorged mesenteric vessels; and displacement of other bowel segments, especially the transverse colon and fourth portion of the duodenum. Left-sided paraduodenal hernias demonstrated a sac-like mass of small-bowel loops interposed between the stomach and pancreatic tail and a posterior mass effect on the stomach. All three paraduodenal hernias were diagnosed confidently at retrospective review of CT and SBFT findings. Transmesenteric hernias demonstrated clustered small-bowel loops adjacent to the abdominal wall without overlying omental fat and central displacement of colon and were frequently complicated by small-bowel volvulus (five of 14) and bowel ischemia (six of 14). CT demonstrated signs of volvulus in four of six patients with ischemia. CT findings considered definitive or suggestive of internal hernia were demonstrated in 15 patients. CONCLUSION Internal hernia is an important and underdiagnosed condition. Transmesenteric hernia is most common in our experience and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis. CT may allow confident diagnosis in most patients.
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Affiliation(s)
- A Blachar
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA
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34
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Abstract
We present a case of a 29-yr-old female nurse who presented with an 8-h history of abdominal pain. She had had similar episodes (twice/yr) over the last 5 yr, and the pain had usually resolved spontaneously. Prior investigations including laboratory studies, plain films of the abdomen, an abdominal and pelvic ultrasound, and a CT scan yielded no diagnosis. Her pain was previously considered to be either psychosomatic or a variant of irritable bowel syndrome. On this admission, an evaluation and subsequent enteroclysis revealed a left paraduodenal hernia. The importance of considering paraduodenal hernias in the differential diagnosis of unexplained intermittent abdominal pain is discussed here.
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Affiliation(s)
- R Patil
- Department of Internal Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
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35
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Affiliation(s)
- J D Casas
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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36
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Weber P, Von Lengerke HJ, Oleszczuk-Rascke K, Schleef J, Zimmer KP. Internal abdominal hernias in childhood. J Pediatr Gastroenterol Nutr 1997; 25:358-62. [PMID: 9285392 DOI: 10.1097/00005176-199709000-00022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- P Weber
- Kinderklinik der Universität Münster, Germany
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37
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Donnelly LF, Rencken IO, deLorimier AA, Gooding CA. Left paraduodenal hernia leading to ileal obstruction. Pediatr Radiol 1996; 26:534-6. [PMID: 8753666 DOI: 10.1007/bf01372236] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Left paraduodenal hernias are a rare cause of abdominal pain or obstruction. However, because there is high associated mortality (20 %), prompt and accurate diagnosis is essential. Because internal hernias are not detectable on physical examination, imaging is relied upon for pre-operative diagnosis. Although both computed tomography and barium studies demonstrate left paraduodenal hernias as a cluster of bowel located posterior to the stomach and to the left of the distal duodenum with absence of the normal interdigitation between loops, the findings may be subtle. Knowledge of these findings can avoid an unnecessary delay in diagnosis. We present the case of a 15-year-old girl with a left paraduodenal hernia, where initial CT and barium studies demonstrated nonobstructed jejunum within the hernia sac. Two weeks later a repeat study showed obstructed distal ileum, rather than proximal jejunum, within the sac.
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Affiliation(s)
- L F Donnelly
- Department of Radiology and Pediatrics, Childrens' Hospital Medical Center, Cincinnati, Ohio, USA
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38
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Walsh G, Williams MP. Congenital anomalies of the portal venous system--CT appearances with embryological considerations. Clin Radiol 1995; 50:174-6. [PMID: 7889709 DOI: 10.1016/s0009-9260(05)83051-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The portal vein is formed by the union of the splenic and superior mesenteric veins behind the neck of the pancreas. This system is derived from the vitelline veins, a component of the extraembryonic venous system. In this paper we report three cases, each of which illustrates a congenital variant of the portal venous system, describe their computed tomography appearances and discuss the embryological processes accounting for these anomalies.
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Affiliation(s)
- G Walsh
- Department of Imaging, Derriford Hospital, Plymouth
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39
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Walker S, Baer JW. Herniation of small bowel through the falciform ligament: CT demonstration. ABDOMINAL IMAGING 1995; 20:161-3. [PMID: 7787723 DOI: 10.1007/bf00201529] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of intestinal obstruction with strangulation due to a hernia through a rent in the falciform ligament is presented to emphasize the diagnostic role of CT imaging in patients without previous surgery.
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Affiliation(s)
- S Walker
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
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