Case Of the Week (COW) 27 March 2016
Internal hernia
Findings
Cluster of dilated proximal jejunal loops (maximum diameter 3 cm) are noted in the left upper quadrant with abrupt tapering. Duodenum is not dilated. The ileum and colon are not dilated. Superior mesenteric artery and vein appear normal. Relatively engorged inferior mesenteric vessels are noted adjoining the transition zone between the dilated and non-dilated jejunal loops.
Discussion
Cluster of dilated proximal jejunal loops (maximum diameter 3 cm) in the left upper quadrant with abrupt tapering. Comments Features suggestive of internal hernia with dilated proximal jejunal loops – likely left para duodenal hernia. The orifice that the small bowel herniates through is usually a pre-existing anatomic structures, such as foramina, recesses, and fossae (e.g. fossa of Landzert). Pathologic defects of the mesentery and visceral peritoneum, such as from congenital maldevelopment of the mesenteries, and surgery also create potential internal herniation orifices. - paraduodenal hernias (most common; ~55% )
Contributed By:
Dr .S. Babu Peter, Dr Srinivasaraman , Dr Suriyakumar, Dr Bhuvana
Anderson Diagnostics, Chennai
Internal hernia
Findings
Cluster of dilated proximal jejunal loops (maximum diameter 3 cm) are noted in the left upper quadrant with abrupt tapering. Duodenum is not dilated. The ileum and colon are not dilated. Superior mesenteric artery and vein appear normal. Relatively engorged inferior mesenteric vessels are noted adjoining the transition zone between the dilated and non-dilated jejunal loops.
Discussion
Cluster of dilated proximal jejunal loops (maximum diameter 3 cm) in the left upper quadrant with abrupt tapering. Comments Features suggestive of internal hernia with dilated proximal jejunal loops – likely left para duodenal hernia. The orifice that the small bowel herniates through is usually a pre-existing anatomic structures, such as foramina, recesses, and fossae (e.g. fossa of Landzert). Pathologic defects of the mesentery and visceral peritoneum, such as from congenital maldevelopment of the mesenteries, and surgery also create potential internal herniation orifices. - paraduodenal hernias (most common; ~55% )
Contributed By:
Dr .S. Babu Peter, Dr Srinivasaraman , Dr Suriyakumar, Dr Bhuvana
Anderson Diagnostics, Chennai