Case 5
History:
39 year old female chronic right sided abdominal pain
Findings:
Enhanced CT of the abdomen showing a focally grouped small bowel loops within the right mid abdominal region with less opacification than the rest of the adjacent small bowel loops
Diagnosis:
Right internal para duodenal hernia (surgically proven)
Discussion:
Para duodenal hernias (PDH) are reported in 0.2 – 0.9 percent of autopsies. Internal hernias are uncommon and are rarely preoperatively diagnosed because there are no specific clinical symptoms. PDHs constitute approximately 53 percent of all internal hernias. Approximately three-fourths of these hernias occur on the left and are more predominant in men than in women, with a ratio of about 3:1. Right PDH involves the Fossa of Waldeyer, which is located immediately behind the superior mesenteric artery and inferior to the transverse segment of the duodenum with or without rotation anomaly. Left PDH develops through the fossa of Landzert into the descending mesocolon and left of the transverse mesocolon and results from failure of fusion of the inferior mesentery to the parietal peritoneum. The characteristic CT of right PDH appearance consists of an abnormal cluster or saclike mass of dilated small bowel loops lying just inferior the pancreas.
References:
- Mayers MA. Internal abdominal hernias. In: Mayers MA, ed. Dynamic radiology of the abdomen. 5th ed. New York, NY: Springer-Verlag, 2000; 711–748.
- Ghahremani GG. Internal abdominal hernias. Surg Clin North Am 1984; 64:393–406.
- Ghahremani GG. Abdominal and pelvic hernias. In: Gore RM, Levine MS, eds. Textbook of gastrointestinal radiology. 2nd ed. Philadelphia, Pa: Saunders, 2000; 1993–2009.
- Newsom BD, Kukora JS. Congenital and acquired internal hernias: unusual causes of small bowel obstruction. Am J Surg 1986; 152:279–285
