Transmesenteric internal hernia

Discussion:

This is a case of a transmesenteric internal hernia. There is no history of previous surgery to account for the mesenteric defect. There is no malrotation.

There is no strangulation at present. Signs of strangulation include bowel wall thickening inside the hernial sac, lack of SMV enhancement, fluid in the hernial sac and fat stranding in the herniated bowel mesentery.

Internal hernias can be overlooked if the large bowel is not traced carefully.

A useful sign to alert the radiologist to a possible internal hernia is seeing the cecum abnormally positioned, with the additional clue of seeing the small bowel surrounding the outside the large bowel (as illustrated).\

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