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Internal hernias in children: spectrum of clinical and imaging findings

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Abstract

Background

Internal hernias are uncommon in children and their clinical and imaging findings have not been widely addressed.

Objective

To determine the spectrum of clinical and imaging findings of internal hernia (IH) in children and to highlight diagnostic features.

Materials and methods

Review of clinical, imaging and surgical findings in 12 children with surgically proven IH.

Results

IH found in seven girls and five boys. Five of the children were neonates and seven were between ages 8–17 years. All neonates presented acutely and had transmesenteric internal hernias (TMIH) (four congenital, one acquired). In the older children, five presented with chronic symptoms and two presented with acute symptoms; the former had paraduodenal hernias (all congenital) and the latter had a congenital pericecal and an acquired TMIH. Only 2/5 neonatal TMIH could be appreciated on GI contrast examination. All five paraduodenal hernias were easily diagnosed on UGI series. CT, in two older children, depicted a paraduodenal hernia and the acquired TMIH. In 7/10 (70%) congenital IH, there was associated malrotation (in all four right paraduodenal hernias).

Conclusion

There is a wide spectrum of clinical and imaging findings of IH in children. TMIH were difficult to appreciate on GI contrast examinations, but paraduodenal hernias were easy to appreciate. One must have a high index of suspicion for right paraduodenal hernia if UGI series shows duodenum and proximal small bowel to the right of the spine.

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Author information

Author notes

  1. Stephen F. Miller

    Present address: Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA

Authors and Affiliations

  1. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Vivian Tang, Alan Daneman, Oscar M. Navarro & Stephen F. Miller

  2. Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, ON, Canada

    Vivian Tang, Alan Daneman, Oscar M. Navarro & Stephen F. Miller

  3. Department of Surgery, University of Toronto, Toronto, ON, Canada

    J. Ted Gerstle

  4. Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Canada

    J. Ted Gerstle

Authors
  1. Vivian Tang
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  2. Alan Daneman
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  3. Oscar M. Navarro
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  4. Stephen F. Miller
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  5. J. Ted Gerstle
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Corresponding author

Correspondence to Alan Daneman.

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Tang, V., Daneman, A., Navarro, O.M. et al. Internal hernias in children: spectrum of clinical and imaging findings. Pediatr Radiol 41, 1559–1568 (2011). https://doi.org/10.1007/s00247-011-2158-4

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  • DOI: https://doi.org/10.1007/s00247-011-2158-4

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