Internal Hernias in the Era of Multidetector CT: Correlation of Imaging and Surgical Findings

Abstract

Clinical diagnosis of internal hernias is challenging because of their nonspecific signs and symptoms. Many types of internal hernias have been defined: paraduodenal, small bowel mesentery-related, greater omentum-related, lesser sac, transverse mesocolon-related, pericecal, sigmoid mesocolon-related, falciform ligament, pelvic internal, and Roux-en-Y anastomosis-related. An internal hernia is a surgical emergency that can develop into intestinal strangulation and ischemia. Accurate preoperative diagnosis is crucial for appropriate management. Multidetector computed tomography (CT), with its thin-section axial images, high-quality multiplanar reformations, and three-dimensional images, currently plays an essential role in preoperative diagnosis of internal hernias. The diagnostic approach to internal hernias at multidetector CT includes detecting an intestinal closed loop, identifying the hernia orifice, and analyzing abnormal displacement of surrounding structures and key vessels around the hernia orifice and hernia sac. At each step, multidetector CT can depict pathognomonic findings. A saclike appearance suggests an intestinal closed loop in several types of internal hernias. Convergence, engorgement, and twisting of mesenteric vessels in the hernia orifice can be seen clearly at multidetector CT, especially with use of multiplanar reformations. For definitive diagnosis of an internal hernia, analysis of displacement of anatomic landmarks around the hernia orifice is particularly important, and thin-section images provide the required information. Detailed knowledge of the anatomy, etiology, and imaging landmarks of the various hernia types is also necessary. Familiarity with the appearances of internal hernias at multidetector CT allows accurate and specific preoperative diagnosis. (©)RSNA, 2015.

Congenital Trans Mesenteric Hernia (CTMH) in a Female Patient with Familial Mediterranean fever (FMF): Case Report and Review of the Literature

“…Congenital trans-mesenteric hernia (CTMH) is a protrusion of the viscera through defect between transverse colon and descending colon; the left upper area of the abdominal cavity; as in our condition. It mainly affects children; caused by congenital mechanisms such as error in the rotation of the midgut, or in adults; after surgery, inflammation and trauma [8,9].…”

“…In regard to treatment, surgical options; either open or laparoscopic, are considered the cornerstone for repair of the hernia defect [8].…”

Congenital internal hernia through defect in the falciform ligament in adult: A case report and review of the literature

“…Furthermore, that ileal loop had thickened wall, decreased contrast enhancement with perivisceral fluid: these signs are suggestive of vascular suffering. On the base of these findings was performed the suspect of an internal hernia in the site of falciform ligament [17], [18], [19], [20]. Nevertheless, because of the preoperative diagnosis is very difficult, laparoscopic approach is mandatory and superior to other diagnostic tools, infact in up to 40% of patients it also can correct an erroneous preoperative diagnosis and exclude other abdominal pathological phenomena; plus the laparoscopic approach allows therapeutic correction of the defect during the same intervention [14].…”

From Bowel Obstruction to Perforation: Role of CT as a Troubleshooter Imaging Modality

“…Inferior mesenteric vein (IMV) and ascending left colic artery are landmarks situated at antero-medial edge of fossa of landzert. With a left paraduodenal hernia, IMV is observed anterior and medial to hernia orifice and entrapped intestine 10,11 (Figure 3 (a)). This are in congruence to findings of our study that also demonstrates a left paraduodenal hernia with the hernial sac in left anterior pararenal space and inferior mesenteric vein being antero-medial to it.…”