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A review of internal hernias related to congenital peritoneal fossae and apertures

Abstract

Congenital-type internal hernias have the potential to cause small bowel obstruction well into adulthood. Congenital-type internal hernias include left paraduodenal, right paraduodenal, foramen of Winslow, pericecal, sigmoid mesocolon, transomental, small bowel mesentery, and broad ligament hernias. This review summarizes CT imaging features and complications of congenital internal hernias using a systematic approach based on abdominopelvic quadrants and key anatomic features. CT imaging will continue to be commonly used to evaluate abdominal pain. Anatomical landmarks and characteristic CT findings can help identify congenital internal hernias as a potential cause of abdominal pain.

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Acknowledgements

The authors would like to acknowledge the work and contribution of medical illustrator David Botos.

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Correspondence to Linda Kelahan.

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Supplementary material 1 (MP4 6899 kb) Online Supplementary Material 1 a-b Left Paraduodenal Hernia. 48-year-old female with sudden abdominal pain with a left paraduodenal hernia. Axial (a) and coronal (b) CT movie clips demonstrating encapsulated, dilated small bowel loops (circle) in the left upper quadrant behind the inferior mesenteric vein with stretched mesenteric vessels and interloop fluid suggesting mesenteric congestion/early ischemia

Supplementary material 2 (MP4 9191 kb)

Supplementary material 3 (MP4 5791 kb) Online Supplementary Material 2 a-b Right Paraduodenal Hernia. 46-year-old male with abdominal pain and right paraduodenal hernia. Axial (a) and coronal (b) CT movie clips show clustered small bowel in the right upper quadrant (circle) below the level of the transverse duodenum. These bowel loops are in close association with the ascending colon. The branches of the SMA and SMV course behind their parent vessels into the right upper quadrant. Note that the patient is malrotated (a common association with RPDH): the third portion of the duodenum does not cross behind the SMA

Supplementary material 4 (MP4 7615 kb)

Supplementary material 5 (MP4 7957 kb) Online Supplementary Material 3 Foramen of Winslow hernia. 69-year-old female with epigastric pain and Foramen of Winslow hernia. Axial CT movie clip demonstrating herniation of the cecum into the lesser peritoneal sac, between the IVC and portal vein. Herniated cecum actually narrows the portal vein, a common imaging finding in this hernia

Supplementary material 6 (MP4 14104 kb) Online Supplementary Material 4 a-b Pericecal hernia. 35-year-old male with acute right lower quadrant pain with pericecal hernia. Axial (a) and coronal (b) CT movie clips with right lower quadrant hernia sac (circle) behind the anteriorly displaced cecum and ileocecal junction in a pericecal fossa. Note the stretched mesenteric vessels

Supplementary material 7 (MP4 11933 kb)

Supplementary material 8 (MP4 14126 kb) Online Supplementary Material 5 Intersigmoid hernia. 23-year-old male with acute left lower quadrant pain with intersigmoid hernia. Coronal CT movie clip demonstrates encapsulated appearing, fluid-filled small bowel with decreased enhancement in the pelvis (circle), stretching and displacing the sigmoid colon

Supplementary material 9 (MP4 9078 kb) Online Supplementary Material 6 a-b Broad ligament hernia. 48-year-old female with no past medical or surgical history presenting with lower abdominal pain and emesis found to have a small bowel obstruction caused by anterior to posterior herniation of long segment small bowel through a defect in the left broad ligament. Axial (a) and coronal (b) CT movie clip demonstrating fluid-filled, mildly dilated small bowel in the left lower quadrant with abrupt transition point at the left broad ligament. There is herniation of decompressed small bowel loops with stretched mesenteric vessels into the pelvis causing rightward deviation of the uterus

Supplementary material 10 (MP4 12716 kb)

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Kelahan, L., Menias, C.O. & Chow, L. A review of internal hernias related to congenital peritoneal fossae and apertures. Abdom Radiol 46, 1825–1836 (2021). https://doi.org/10.1007/s00261-020-02829-4

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Keywords

  • Internal hernia
  • CT
  • Congenital
  • Abdominal pain
  • Bowel obstruction