Presentation
Acute abdominal pain of short duration. Previous unspecified abdominal surgery.
Patient Data
Proximal small bowel closed loop obstruction with ischemic segment of jejunum due to an internal hernia.
Annotation of the closed loop obtruction from the internal hernia
The tight neck of the internal hernia (green line) showing (red arrows) the entry and exit loops resulting in a closed loop obstruction of the proximal jejenum.
The segment of contained jejunum is thickened and non enhancing in keeping with focal ischemia.
Small amount of intraperitoneal free fluid. No perforation.
Histopathology
Gross: segment of small intestine measuring 25cm. The entire thickness of the wall and mucosa is drak red in color.
Microscopy: The small intestine shows infarction, necrosis and grangrene involving the full thickness of the intestinal wall. No vascular thrombosis.
Comment: Ischemic necrosis of proximal jejunal loop
Case Discussion
Internal hernias are well described, but usually challenging to identify on CT without the help of the surgical retrospectoscope.
In this case a short segment of jejunum just distal to the DJ flexure is containing within a internal hernia, with a resultant closed loop obstruction. A segment of ischemic bowel results.
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