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Gastrointestinal
Diagnosis
Peritoneum, Mesentery, and Abdominal Wall
Internal Hernias
Transmesenteric Postoperative Hernia
Transmesenteric Postoperative Hernia
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Transmesenteric congenital hernia

            • Definitions

              • Internal hernia with protrusion of bowel loops through acquired or congenital abdominal mesenteric defect

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Fluoroscopic Findings

                    • Ultrasonographic Findings

                      • Angiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Kelahan L et al: A review of internal hernias related to congenital peritoneal fossae and apertures. Abdom Radiol (NY). 46(5):1825-36, 2021
                                              2. Bordonaro V et al: Role of CT imaging in discriminating internal hernia from aspecific abdominal pain following Roux-en-Y gastric bypass: a single high-volume centre experience. Updates Surg. 72(4):1115-24, 2020
                                              3. Ederveen JC et al: Structured CT reporting improves accuracy in diagnosing internal herniation after laparoscopic Roux-en-Y gastric bypass. Eur Radiol. 30(6):3448-54, 2020
                                              4. Kundaragi NG et al: Stretched bowel sign in combined transmesocolic and transomental internal hernia: a case report and review of literature. Indian J Radiol Imaging. 24(2):171-4, 2014
                                              5. Al-Saeed O et al: Sixty-four-slice multidetector computerized tomography in the evaluation of transmesenteric internal hernias following Roux-en-Y bariatric surgery. Med Princ Pract. 22:540-4, 2013
                                              6. Tang V et al: Internal hernias in children: spectrum of clinical and imaging findings. Pediatr Radiol. 41(12):1559-68, 2011
                                              7. Iannuccilli JD et al: Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol. 64(4):373-80, 2009
                                              8. Patel RY et al: Internal hernia complications of gastric bypass surgery in the acute setting: spectrum of imaging findings. Emerg Radiol. 16(4):283-9, 2009
                                              9. Ghiassi S et al: Internal hernias: clinical findings, management, and outcomes in 49 nonbariatric cases. J Gastrointest Surg. 11(3):291-5, 2007
                                              10. Agarwal A et al: Internal hernia after pancreas transplantation with enteric drainage: an unusual cause of small bowel obstruction. Transplantation. 80(1):149-52, 2005
                                              11. Hong SS et al: Current diagnostic role of CT in evaluating internal hernia. J Comput Assist Tomogr. 29(5):604-9, 2005
                                              12. Osadchy A et al: Small bowel obstruction due to a paracecal hernia: computerized tomography diagnosis. Emerg Radiol. 11(4):239-41, 2005
                                              13. Catalano OA et al: Internal hernia with volvulus and intussusception: case report. Abdom Imaging. 29(2):164-5, 2004
                                              14. Blachar A et al: Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 223(3): 625-32, 2002
                                              15. Blachar A et al: Internal hernia: an increasingly common cause of small bowel obstruction. Semin Ultrasound CT MR. 23(2): 174-83, 2002
                                              16. Filip JE et al: Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Am Surg. 68(7): 640-3, 2002
                                              17. Blachar A et al: Bowel obstruction following liver transplantation: clinical and ct findings in 48 cases with emphasis on internal hernia. Radiology. 218(2): 384-8, 2001
                                              18. Blachar A et al: Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology. 218(1): 68-74, 2001
                                              19. Blachar A et al: Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology. 221(2): 422-8, 2001
                                              20. Delabrousse E et al: Strangulated transomental hernia: CT findings. Abdom Imaging. 26(1): 86-8, 2001
                                              21. Huang YC et al: Left paraduodenal hernia presenting as intestinal obstruction: report of one case. Acta Paediatr Taiwan. 42(3): 172-4, 2001
                                              22. Rha SE et al: CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics. 20(1): 29-42, 2000
                                              23. Ha HK et al: Usefulness of CT in patients with intestinal obstruction who have undergone abdominal surgery for malignancy. AJR Am J Roentgenol. 171(6): 1587-93, 1998
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Transmesenteric congenital hernia

                                                        • Definitions

                                                          • Internal hernia with protrusion of bowel loops through acquired or congenital abdominal mesenteric defect

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • Fluoroscopic Findings

                                                                • Ultrasonographic Findings

                                                                  • Angiographic Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Staging, Grading, & Classification

                                                                            • Gross Pathologic & Surgical Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Kelahan L et al: A review of internal hernias related to congenital peritoneal fossae and apertures. Abdom Radiol (NY). 46(5):1825-36, 2021
                                                                                          2. Bordonaro V et al: Role of CT imaging in discriminating internal hernia from aspecific abdominal pain following Roux-en-Y gastric bypass: a single high-volume centre experience. Updates Surg. 72(4):1115-24, 2020
                                                                                          3. Ederveen JC et al: Structured CT reporting improves accuracy in diagnosing internal herniation after laparoscopic Roux-en-Y gastric bypass. Eur Radiol. 30(6):3448-54, 2020
                                                                                          4. Kundaragi NG et al: Stretched bowel sign in combined transmesocolic and transomental internal hernia: a case report and review of literature. Indian J Radiol Imaging. 24(2):171-4, 2014
                                                                                          5. Al-Saeed O et al: Sixty-four-slice multidetector computerized tomography in the evaluation of transmesenteric internal hernias following Roux-en-Y bariatric surgery. Med Princ Pract. 22:540-4, 2013
                                                                                          6. Tang V et al: Internal hernias in children: spectrum of clinical and imaging findings. Pediatr Radiol. 41(12):1559-68, 2011
                                                                                          7. Iannuccilli JD et al: Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol. 64(4):373-80, 2009
                                                                                          8. Patel RY et al: Internal hernia complications of gastric bypass surgery in the acute setting: spectrum of imaging findings. Emerg Radiol. 16(4):283-9, 2009
                                                                                          9. Ghiassi S et al: Internal hernias: clinical findings, management, and outcomes in 49 nonbariatric cases. J Gastrointest Surg. 11(3):291-5, 2007
                                                                                          10. Agarwal A et al: Internal hernia after pancreas transplantation with enteric drainage: an unusual cause of small bowel obstruction. Transplantation. 80(1):149-52, 2005
                                                                                          11. Hong SS et al: Current diagnostic role of CT in evaluating internal hernia. J Comput Assist Tomogr. 29(5):604-9, 2005
                                                                                          12. Osadchy A et al: Small bowel obstruction due to a paracecal hernia: computerized tomography diagnosis. Emerg Radiol. 11(4):239-41, 2005
                                                                                          13. Catalano OA et al: Internal hernia with volvulus and intussusception: case report. Abdom Imaging. 29(2):164-5, 2004
                                                                                          14. Blachar A et al: Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 223(3): 625-32, 2002
                                                                                          15. Blachar A et al: Internal hernia: an increasingly common cause of small bowel obstruction. Semin Ultrasound CT MR. 23(2): 174-83, 2002
                                                                                          16. Filip JE et al: Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Am Surg. 68(7): 640-3, 2002
                                                                                          17. Blachar A et al: Bowel obstruction following liver transplantation: clinical and ct findings in 48 cases with emphasis on internal hernia. Radiology. 218(2): 384-8, 2001
                                                                                          18. Blachar A et al: Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology. 218(1): 68-74, 2001
                                                                                          19. Blachar A et al: Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology. 221(2): 422-8, 2001
                                                                                          20. Delabrousse E et al: Strangulated transomental hernia: CT findings. Abdom Imaging. 26(1): 86-8, 2001
                                                                                          21. Huang YC et al: Left paraduodenal hernia presenting as intestinal obstruction: report of one case. Acta Paediatr Taiwan. 42(3): 172-4, 2001
                                                                                          22. Rha SE et al: CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics. 20(1): 29-42, 2000
                                                                                          23. Ha HK et al: Usefulness of CT in patients with intestinal obstruction who have undergone abdominal surgery for malignancy. AJR Am J Roentgenol. 171(6): 1587-93, 1998