Presentation
Post emergency cesarean due to intractable abdominal pain of unknown origin. History of bariatric surgery. Ascitic fluid on ultrasound.
Patient Data
Post-surgical changes due to bariatric surgery and a recent cesarean section.
Mild dilatation of intestinal loops in the left flank with mesentery edema and partial compression of the superior mesenteric artery and adjacent veins. Some intestinal loops are displaced to the left. Preserved bowel loop enhancement.
Free fluid is in the pelvis and right paracolic gutter.
The differential diagnosis between internal hernia and occlusion by abdominal adhesion is considered. The patient underwent emergency surgery. The surgical report confirms the presence of internal hernia through a mesenteric defect, probably due to a history of bariatric surgery.
Case Discussion
Internal hernias (IH) consist of protrusion, normally small bowel loops, through a peritoneal or mesenteric defect. The cause may be congenital or acquired. Among these, bariatric surgery stands out due to the increase in this type of intervention in recent years.
IH requires emergent treatment due to the risk of intestinal ischemia. In this case, an emergency cesarean section was decided because a gynecological cause was thought at first. However, as mentioned above, IH is one of the differential diagnoses, together with abdominal adhesions, to be considered in cases of previous surgeries. Therefore, in view of the presence of free fluid on ultrasound, it was decided to perform a CT scan.
These types of IH are difficult to detect due to the variability of location. They are usually caused by defects in the repair of defects in mesentery, although they are more frequent after the first few months.
Unable to process the form. Check for errors and try again.