Internal hernia with ischemic jejunum

Case contributed by Dr Ian Bickle


Acute abdominal pain of short duration. Previous unspecified abdominal surgery.

Patient Data

Age: 50
Gender: Male

Proximal small bowel closed loop obstruction with ischemic segment of jejunum due to an internal hernia.

Annotated image

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.


Gross: segment of small intestine measuring 25cm.  The entire thickness of the wall and mucosa is drak red in colour.

Microscopy: The small intestine shows infarction, necrosis and grangrene involving the full thickness of the intestinal wall. No vascular thrombosis.

Comment: Ischaemic 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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Case information

rID: 28601
Published: 2nd Apr 2014
Last edited: 29th Dec 2019
Inclusion in quiz mode: Included

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