Internal Herniation of the Small Bowel Through a Mesosalpinx Defect: GI Image

Abstract

A 33-year-old Caucasian woman presented to our attention with generalized abdominal tenderness, abdominal distension, and vomiting. Her last bowel movement was 3 days before admission to the emergency room. Past medical and surgical history was unremarkable. On physical examination, abdominal distension with diffuse tenderness on palpation and a reduction of bowel sounds on auscultation were present. Laboratory studies were normal. An abdominal CT scan showed a closedloop image in the right iliac fossa lateral to the uterine body, dilated small bowel loops containing air-fluid levels, and a fluid collection posterior to the closed loop (Fig. 1). Exploratory laparoscopy was performed, identifying the herniation of the penultimate ileal loop through a congenital defect of the right mesosalpinx (Figs. 2 and 3). An enlargement of the mesosalpinx defect by scissors was required to free the irreducible loop. There 3