Demonstration by computed tomography of a case of internal small bowel herniation.

Abstract

Internal hernia is a rare condition. We report a case where computed tomography (CT) demonstrated a saclike encapsulation of small bowel loops which suggested a diagnosis of internal hernia. A 76-year-old woman presented with abdominal pain and vomiting. Ultrasound examination revealed a 10 cm heterogenous mass posterior to the bladder, close to the ovaries, associated with bilateral hydronephrosis affecting mainly the left side. Contrast-enhanced CT showed a large pelvic mass Fig. 1), behind the bladder, of fluid density and containing septations. The appearance suggested dilated loops of small bowel. Both ureters were dilated, and a plain film of the abdomen 24 h after injection of contrast medium (Fig. 2) showed marked left hydronephrosis and less severe dilatation the right renal tract. Forty-eight hours after injection Fig. 3) the left ureter was still opacified. At laparotomy a cluster of dilated and congested loops of small bowel were found posterior to the bladder and these were strangulated in the pouch of Douglas. Resection of 50 cm of ileum was necessary, following which the patient made a full recovery.