As per the operation note (see below), the CT findings were confirmed on laparotomy.

The features on the CT demonstrate conclusively that this is an internal hernia, probably iatrogenic, secondary to the previous jejuno-ileal anastomosis.

The CT features cataloged above are all indicative of a mesenteric internal hernia which is incarcerated and has CT findings of early strangulation. These can occur spontaneously or secondary to surgery.

Surgical operation note (abridged):

Laparoscopic converted to open reduction of internal hernia and closure of the mesenteric defect.

Finding: Jejuno-ileal bypass, mesenteric defect open. All of common channel, right colon and mid transverse herniated through mesenteric defect of jejuno-ileal anastomosis with evidence of venous congestion and large bowel obstruction. Free purulent fluid in pelvis.

Procedure: attempt at lap reduction of hernia not possible - decision to convert. Common channel, right colon and mid transverse reduced. All pinked up once reduced. All viable. Mesenteric defect closed.

Case presented with:

Dr Tony Booth FRCR, Radiology Reporting Online  

Mr Marco Adamo MD, Laparoscopic Bariatric Surgeon

Ms Jihene El Kafsi FRCS, Bariatric Fellow

UCLH Bariatric Center for Weight Management and Metabolic Surgery