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Internal Abdominal Herniations

¹ Services de Radiologie et d'Imagerie Médicale, Hôpital Henri Mondor, 51 ave. du Maréchal de Lattre de Tassigny, Créteil 94010, France.
² Groupe d'Etude Radiologique des Maladies de l'Appareil Digestif (GERMAD), Paris, France

View larger version (95K): [in a new window]   Fig. 1. —Illustration shows typical locations of different types of internal abdominal herniations: 1 = paraduodenal, 2 = foramen of Winslow, 3 = transmesenteric, 4 = pericecal, 5 = intersigmoid, 6 = paravesical (pelvic). (Reprinted and modified with permission from [5])

View larger version (96K): [in a new window]   Fig. 2A. —Illustrations detail development of left-sided paraduodenal hernia. (Reprinted with permission from [1]) Small-bowel loops herniate into descending mesocolon through paraduodenal fossa posterior to inferior mesenteric vein and ascending left colic artery.

View larger version (97K): [in a new window]   Fig. 2B. —Illustrations detail development of left-sided paraduodenal hernia. (Reprinted with permission from [1]) Small-bowel loops progressively herniate through abnormal peritoneal pocket.

View larger version (106K): [in a new window]   Fig. 2C. —Illustrations detail development of left-sided paraduodenal hernia. (Reprinted with permission from [1]) Both inferior mesenteric vein and left ascending colic artery always remain anterior to neck of herniated sac in left-sided paraduodenal hernia.

View larger version (114K): [in a new window]   Fig. 3A. —41-year-old man who complained of midabdominal pain and nausea. Conventional abdominal radiograph obtained with patient supine shows mass in left upper quadrant (asterisk) compressing both stomach (single arrowhead) and transverse colon (double arrowhead).

View larger version (109K): [in a new window]   Fig. 3B. —41-year-old man who complained of midabdominal pain and nausea. Radiograph from small-bowel series shows circumscribed ovoid mass of multiple jejunal loops in left upper quadrant (asterisk) immediately lateral to fourth portion of duodenum (arrowhead).

View larger version (122K): [in a new window]   Fig. 3C. —41-year-old man who complained of midabdominal pain and nausea. Delayed radiograph of small bowel shows stasis of barium in herniated loops (double arrowhead). Left-sided paraduodenal hernia was found at surgery.

View larger version (118K): [in a new window]   Fig. 4A. —37-year-old man who presented with intense abdominal pain and vomiting. Contrast-enhanced CT scan shows clustered dilated jejunal loops (asterisk) displacing posterior duodenal wall (arrowhead) anteriorly.

View larger version (128K): [in a new window]   Fig. 4B. —37-year-old man who presented with intense abdominal pain and vomiting. Contrast-enhanced CT scan obtained at lower level than (A) confirms dilatation of jejunal loops with visualization of air–fluid levels (arrowhead).

View larger version (120K): [in a new window]   Fig. 4C. —37-year-old man who presented with intense abdominal pain and vomiting. Contrast-enhanced CT scan obtained at duodenojejunal junction shows abnormal course of mesenteric vessels (arrow) through paraduodenal fossa. Left-sided paraduodenal hernia was found at surgery.

View larger version (132K): [in a new window]   Fig. 5A. —59-year-old woman who presented with acute onset of mid upper abdominal pain. Contrast-enhanced CT scan of upper abdomen shows clustering of jejunal loops (asterisk) with anterior displacement of pancreatic body (arrowhead).

View larger version (126K): [in a new window]   Fig. 5B. —59-year-old woman who presented with acute onset of mid upper abdominal pain. Contrast-enhanced CT scan shows herniation of small-bowel loops (asterisk) extending toward descending mesocolon

View larger version (120K): [in a new window]   Fig. 5C. —59-year-old woman who presented with acute onset of mid upper abdominal pain. Contrast-enhanced CT scan reveals abnormal disposition of mesentery (arrowhead) marked by fat and vessels close to trapped loops. Left-sided paraduodenal hernia was found at surgery.

View larger version (123K): [in a new window]   Fig. 6. —In drawing depicting formation of right-sided paraduodenal hernia, small-bowel loops are seen herniating through Waldeyer's fossa toward ascending mesocolon. Note position of superior mesenteric artery in anterior margin of neck of hernial sac. (Reprinted with permission from [1])

View larger version (129K): [in a new window]   Fig. 7. —63-year-old man who presented with mid and upper abdominal pain and nausea that had increased in intensity over preceding 2 days. Radiograph from small-bowel series shows ovoid grouping of jejunal loops (asterisk) in right mid abdomen. Right-sided paraduodenal hernia was found at surgery.

View larger version (133K): [in a new window]   Fig. 8A. —57-year-old man who presented with intense abdominal pain and vomiting. Asterisk indicates small-bowel loop. Contrast-enhanced CT scan of upper abdomen suggests presence of right-sided paraduodenal hernia: Distended small-bowel loop with air–fluid level protrudes behind second portion of duodenum.

View larger version (124K): [in a new window]   Fig. 8B. —57-year-old man who presented with intense abdominal pain and vomiting. Asterisk indicates small-bowel loop. Contrast-enhanced CT scan reveals protrusion of herniated loops (arrowhead) through Waldeyer's fossa lateral to second portion of duodenum.

View larger version (120K): [in a new window]   Fig. 8C. —57-year-old man who presented with intense abdominal pain and vomiting. Asterisk indicates small-bowel loop. Contrast-enhanced CT scan reveals position of major mesenteric vessels, particularly superior mesenteric artery (arrow) located at anterior margin of neck of hernial sac.

View larger version (105K): [in a new window]   Fig. 9A. —32-year-old man whose clinical symptoms suggested small-bowel obstruction. Contrast-enhanced CT scan of abdomen reveals presence of large right-sided paraduodenal hernia marked by clustering and encapsulation of small-bowel loops (asterisk) in right mid abdomen.

View larger version (95K): [in a new window]   Fig. 9B. —32-year-old man whose clinical symptoms suggested small-bowel obstruction. Contrast-enhanced CT scan reveals that superior mesenteric artery (arrow) is anterior to and compressed by herniated loops (asterisk). Right-sided paraduodenal hernia was confirmed at surgery.

View larger version (171K): [in a new window]   Fig. 10A. —45-year-old man with acute onset of midabdominal pain and nausea. Contrast-enhanced CT scan of upper abdomen reveals distended portacaval space between inferior vena cava (black arrowhead) and portal trunk (white arrowhead) that has been replaced by mesenteric fat and vessels.

View larger version (141K): [in a new window]   Fig. 10B. —45-year-old man with acute onset of midabdominal pain and nausea. Contrast-enhanced CT scan reveals protrusion of abnormally located bowel loops marked by air–fluid levels (arrowhead) through epiploic foramen of Winslow.

View larger version (196K): [in a new window]   Fig. 10C. —45-year-old man with acute onset of midabdominal pain and nausea. Scout radiograph shows clustering of small-bowel loops (arrow) in upper mid abdomen with lateral displacement of stomach (S).

View larger version (111K): [in a new window]   Fig. 11. —41-year-old woman who reported progressive onset of mild abdominal discomfort and diarrhea. Radiograph from small-bowel study shows distended small-bowel loop (arrowhead) trapped between sigmoid loops (arrow). Intersigmoid hernia was confirmed at surgery.

View larger version (113K): [in a new window]   Fig. 12. —67-year-old woman who presented with mild fever and left-sided abdominal pain. Contrast-enhanced CT scan shows presence of encapsulated fluid-filled and markedly distended bowel loops (asterisk) protruding toward left lower abdomen through intersigmoid fossa accompanied by fat and mesenteric vessels (arrow). Intersigmoid hernia was confirmed at surgery.

View larger version (114K): [in a new window]   Fig. 13. —37-year-old man whose abdominal pain had progressively increased over preceding 24 hr. Contrast-enhanced CT scan of lower abdomen suggests presence of transmesenteric hernia. Encapsulated fluid-filled and markedly distended bowel loops (arrow) protrude toward left abdomen through defect in mesentery (asterisk), which contains peritoneal fluid. Acute arterial ischemia of small bowel caused by transmesenteric hernia was found at surgery.

View larger version (113K): [in a new window]   Fig. 14. —65-year-old woman with lower abdominal pain and mild fever resulting from paravesical hernia. Contrast-enhanced CT scan of pelvis shows herniation of small-bowel loops through left broad ligament. Thickened and hypodense walls of entrapped bowel loops with fluid in pouch of Douglas suggest bowel-wall ischemia. Note anterior displacement of left broad ligament (arrowhead).

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