Post gastric bypass transmesenteric internal hernia

Case contributed by Dr Ahmed Samir Mehany

Presentation

Abdominal pain, distension and vomiting.

Patient Data

Age: 40 years
Gender: Female

Post gastric bypass anastomosis with marked mesenteric vessels swirling, engorgement and stretching distal to the jejuno-jejunal anastomosis, abrupt beaking of the distal jejunal loop and abnormal clustering of dilated small bowel segment measures about 3.8 cm diameter and 8 cm length showing small bowel fecal sign and mildly increased wall enhancement.

Collapsed bypassed stomach and duodenum.

Gas distended transverse colon, yet the ascending and descending colon are collapsed.

Marked free abdominopelvic fluid.

Bilateral breast augmentation.

Case Discussion

History of gastric bypass 10 years ago for weight reduction, presented to ER with abdominal pain, distension and vomiting. Urgent CT was requested to rule out internal hernia.

After the diagnosis of transmesenteric internal hernia, the patient was operated on confirming the diagnosis of an internal hernia and viable bowel.

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Case information

rID: 63348
Published: 2nd Oct 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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