Fact-sheet: Internal intestinal hernia


Updated on 10/03/2018 at 8:56 AM

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Definition

Protrusion of abdominal hollow viscera into an intraperitoneal orifice while remaining within the abdominal cavity.

The bowel loops become trapped within a normal orifice (foramen of Winslow), a paranormal orifice (i.e., corresponding to progressive separation of peritoneal fascia normally fused during embryologic development), or an abnormal orifice (iatrogenic).

They account for 1% of occlusive syndromes.

Main types of hernias (in order of frequency):

  • paraduodenal
  • pericecal (transmesocecal)
  • transmesenteric
  • foramen of Winslow
  • intersigmoid (transmesosigmoid)
  • pelvic (including broad ligament)

Clinical features

Acute presentation of severely painful bowel obstruction: abdominal pain, vomiting, obstipation, and abdominal distension.

CT

Small bowel obstruction

Bowel loops in abnormal location

Encapsulation within a peritoneal sac

Signs of bowel ischemia often prominent

Intraperitoneal hernia neck sometimes visible

The appearance often resembles a closed-loop obstruction (double-beak sign) due to adhesions.

Paraduodenal hernia:

- herniated bowel loops located laterally between the stomach and duodenum

Transmesocecal hernia:

- herniated bowel loops located anterior or posterior to the cecum

Transmesosigmoid hernia:

- herniated bowel loops located posterior to the sigmoid colon

Broad ligament hernia:

- pelvic surgery ++

- incarcerated loops with convergence point of the mesenteric leaves to the left of the uterus ++

- displacement of the uterus to the contralateral side