Small Internal Hernias in the Paraduodenal Area

Internal Hernia: Clinical and Imaging Findings in 17 Patients with Emphasis on CT Criteria

“…The radiographic and CT criteria that we evaluated (our criteria) were based on knowledge gained from prior radiology publications (1-7,10), our own prior imaging experience with internal hernias, and the characteristic altered anatomy described (11)(12)(13)(14)(15) in surgical series of internal hernias (Fig 1). The radiographic and CT criteria that we evaluated (our criteria) were based on knowledge gained from prior radiology publications (1-7,10), our own prior imaging experience with internal hernias, and the characteristic altered anatomy described (11)(12)(13)(14)(15) in surgical series of internal hernias (Fig 1).…”

“…Paraduodenal hernias are usually leftsided (75% of reported cases [2][3][4][5][6][11][12][13][14][15]; 100% of ours) and are believed to occur due to a congenital defect in the descending mesocolon. The small bowel may invaginate into this space, the fossa of Landzert, which lies to the left of the fourth portion of the duodenum.…”

“…The other types of internal hernia that have been described (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) include transmesenteric, supra-and/or perivesical, intersigmoid, foramen of Winslow, and rarely, omental hernias. The other types of internal hernia that have been described (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) include transmesenteric, supra-and/or perivesical, intersigmoid, foramen of Winslow, and rarely, omental hernias.…”

“…Several investigators (1,(11)(12)(13) have noted that internal hernias are difficult to diagnose with both clinical and imaging studies. In reviews (1,(11)(12)(13) of more than 400 cases, the diagnosis was established at autopsy or surgery, often after prolonged symptoms and complications, such as bowel ischemia.…”

An Obstructed Left Paraduodenal Hernia Complicating Recovery from Appendectomy

“…If not, it is safe to open the left mesocolon at an avascular site and to enter the hernial sac to aid reduction. Many different ap proaches have been described to deal with the hernia [11][12][13][14][15][16]. Opinion varies as to whether it is safe to sacri fice the inferior mesenteric vessels (artery and vein) to allow widening of the neck of the sac.…”