Images in Clinical Medicine
Small-Bowel Obstruction Due to an Internal Hernia
N Engl J Med 2007; 356:1152March 15, 2007
- Article
A 48-year-old healthy woman presented with anorexia of 2 days' duration and abdominal pain in the right lower quadrant. Since appendicitis was suspected, she underwent a laparoscopic examination. An inflamed mass was seen near the cecum, and diverticulitis was diagnosed. She was treated with bowel rest, fluids, and antimicrobial agents. Two days later, her symptoms worsened, with increased pain in the right lower quadrant, abdominal distention, and decreased bowel sounds. Abdominal radiography showed dilatation of the small intestine, suggestive of obstruction, in the supine position (Panel A) and the upright position (Panel B). An axial computed tomographic scan of the abdomen showed a pericecal internal hernia (Panel C, arrows). The patient underwent an exploratory laparotomy, resulting in lysis of an adhesion and bowel reduction; no bowel resection was required. Her recovery was rapid and uneventful. Pericecal hernias account for 13% of internal hernias. Most commonly, the herniated loop consists of an ileal segment protruding through a defect in the cecal mesentery and extending into the right paracolic gutter. If strangulation occurs, the associated mortality is high.
Kao-Lang Liu, M.D.
Been-Ren Lin, M.D.
National Taiwan University Hospital, Taipei 100, Taiwan
wgl@ntumc.org - Citing Articles (1)
Citing Articles
1
Rathachai Kaewlai, Divya Kurup, Ajay Singh. (2009) Imaging of Abdomen and Pelvis: Uncommon Acute Pathologies. Seminars in Roentgenology 44:4, 228-236
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