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Transmesenteric hernia (internal hernia), small bowel volvulus

Phu JP - MedPix (2007)

View Article: MedPix Image - MedPix Case

Affiliation: White Memorial Medical Center

ABSTRACT

Diagnosis: Transmesenteric hernia (internal hernia), small bowel volvulus

History: 66 year old woman presents to the ED complaining of palpitation X 3 days and abdominal pain X 1-1.5 years. Patient was recently diagnosed with severe anemia and discharged 2 days prior to arrival from another hospital. Patient had a single episode of hematemesis in the ER. Denies CP/SOB/ Fever/ diarrhea/urinary symptoms/ melena/ hematochezia. PMH/PSH: Pyloric strictures status post 2 abdominal surgeries. Social: Denies Alcohol, Smoking, Drugs ROS: Recent weight loss approximately 35 pounds in last year

Findings: CT of Abdomen: 1. Markedly distended stomach and proximal portion of the duodenum with abrupt decompression of the duodenum at the level of the third portion with swirling of mesenteric vessels. Recommend surgical consultation. 2. Multiple loops of fluid filled bowel within the right upper quadrant without discrete evidence of focal bowel wall thickening. Upper GI Series with contrast: 1. Delayed flow of contrast from the duodenal bulb into the proximal C-loop. Once this has occurred, there is an opacification of the proximal jejunal segments which are primarily located in the right upper quadrant.

Ddx: •Mesenteric ischemia •Enteritis •Internal hernia with small bowel volvulus • Adhesive bands

Dxhow: Exploratory laparotomy

Exam: General: A&OX3, Pale, cachectic female HEENT: pale conjunctiva, PERRL, EOMI Neck: Supple, no JVD, FROM Heart: RRR, soft systolic murmur Lungs: Clear to Auscultation Abdomen: Flat abdomen with bowel sounds. TTP in the upper quadrants Extremities: No edema, FROM Neuro: No focal neurological deficits GU: Guaiac positive Labs: WBC: 4.8 Hb: 3.2 Hct: 10.3 Platelet: 184

No MeSH data available.


This cross section shows a swirling pattern of the mesenteric vessels, and fat (arrows) consistent with an internal hernia.
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MPX2129_synpic40358: This cross section shows a swirling pattern of the mesenteric vessels, and fat (arrows) consistent with an internal hernia.


Transmesenteric hernia (internal hernia), small bowel volvulus

Phu JP - MedPix (2007)

This cross section shows a swirling pattern of the mesenteric vessels, and fat (arrows) consistent with an internal hernia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2129&req=5

MPX2129_synpic40358: This cross section shows a swirling pattern of the mesenteric vessels, and fat (arrows) consistent with an internal hernia.

View Article: MedPix Image - MedPix Case

Affiliation: White Memorial Medical Center

ABSTRACT

Diagnosis: Transmesenteric hernia (internal hernia), small bowel volvulus

History: 66 year old woman presents to the ED complaining of palpitation X 3 days and abdominal pain X 1-1.5 years. Patient was recently diagnosed with severe anemia and discharged 2 days prior to arrival from another hospital. Patient had a single episode of hematemesis in the ER. Denies CP/SOB/ Fever/ diarrhea/urinary symptoms/ melena/ hematochezia. PMH/PSH: Pyloric strictures status post 2 abdominal surgeries. Social: Denies Alcohol, Smoking, Drugs ROS: Recent weight loss approximately 35 pounds in last year

Findings: CT of Abdomen: 1. Markedly distended stomach and proximal portion of the duodenum with abrupt decompression of the duodenum at the level of the third portion with swirling of mesenteric vessels. Recommend surgical consultation. 2. Multiple loops of fluid filled bowel within the right upper quadrant without discrete evidence of focal bowel wall thickening. Upper GI Series with contrast: 1. Delayed flow of contrast from the duodenal bulb into the proximal C-loop. Once this has occurred, there is an opacification of the proximal jejunal segments which are primarily located in the right upper quadrant.

Ddx: •Mesenteric ischemia •Enteritis •Internal hernia with small bowel volvulus • Adhesive bands

Dxhow: Exploratory laparotomy

Exam: General: A&OX3, Pale, cachectic female HEENT: pale conjunctiva, PERRL, EOMI Neck: Supple, no JVD, FROM Heart: RRR, soft systolic murmur Lungs: Clear to Auscultation Abdomen: Flat abdomen with bowel sounds. TTP in the upper quadrants Extremities: No edema, FROM Neuro: No focal neurological deficits GU: Guaiac positive Labs: WBC: 4.8 Hb: 3.2 Hct: 10.3 Platelet: 184

No MeSH data available.