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Joseph Junewick, MD FACR
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Paraduodenal Hernia

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: CT RF
Activities:
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History

Teenage female with abdominal pain and history of Crohns disease.


Case Images


Diagnosis

Paraduodenal Hernia

Findings

RF – Mildly prominent loops of proximal jejunum with subtle twisting near the midline.

CT – Dilated loops of bowel in the retrogastric space.

Discussion

Internal hernia may be congenital or acquired and accounts for < 1% of small-bowel obstruction. Herniation of a viscus, usually the small bowel, occurs through a normal or abnormal aperture within the peritoneal cavity. While this herniation may be transient, persistence may result in strangulation of the hernia contents.

About half of internal hernias are paraduodenal. The other types of internal hernia include transmesenteric, supra- and/or perivesical, intersigmoid, foramen of Winslow, and rarely, omental hernias.

Internal hernias are difficult to diagnose with both clinically and by imaging studies. Often the diagnosis is established at autopsy or surgery, often after prolonged symptoms and complications, such as bowel ischemia.

The most commonly seen signs of paraduodenal hernia were clustering of small-bowel loops, a saclike mass with encapsulation at or above the ligament of Treitz, duodenojejunal junction depression, mass effect on the posterior stomach wall, engorgement and crowding of the mesenteric vessels with frequent right displacement of the main mesenteric trunk, and depression of the transverse colon.

Reference

Blachar A, Federle MP. Dodson F. Internal Hernia: Clinical and Imaging Findings in 17 Patients with Emphasis on CT Criteria. Radiology (2001); 218: 68-74.

Contributor

WL Schey, MD



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