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Transmesenteric internal hernia, small bowel volvulus

Harshany MLH - MedPix

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Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Transmesenteric internal hernia, small bowel volvulus

History: 27 y/o woman with sudden onset of periumbilical abdominal pain relieved only by "bending forward". Previous surgery - gastric bypass 2 years ago.

Findings: Early studies demonstrate an internal transmesenteric small bowel hernia without volvulus or ischemia. Recent study demonstrate the "whirl" sign - indicating twisting of the bowel and, hence, volvulus. No evidence of intestinal ischemia or necrosis on CT (no submucosal enhancement, bowel wall thickening, free fluid or pneumatosis intestinalis).

Ddx: Clinical difeerential diagnosis: <li> Acute appendicitis <li> Acute cholecystitis <li> Mesenteric ischemia <li> Volvulus Imaging findings are diagnostic.

Dxhow: Surgery

Exam: Severe periumbilical pain, peritoneal signs. Unable to tolerate oral contrast.

No MeSH data available.


Mesentric root rotation about SMA axis with "whirl sign".  Note engorgement of vessels and a "misty" surrounding fat consistent with vascular congestion.Note that there are no secondary findings for intestinal ischemia (no bowel dilatation, submucosal enhancement, wall thickening or free fluid) suggesting a still viable small bowel (confirmed intraoperatively)
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MPX2481_synpic23901: Mesentric root rotation about SMA axis with "whirl sign". Note engorgement of vessels and a "misty" surrounding fat consistent with vascular congestion.Note that there are no secondary findings for intestinal ischemia (no bowel dilatation, submucosal enhancement, wall thickening or free fluid) suggesting a still viable small bowel (confirmed intraoperatively)


Transmesenteric internal hernia, small bowel volvulus

Harshany MLH - MedPix

Mesentric root rotation about SMA axis with "whirl sign".  Note engorgement of vessels and a "misty" surrounding fat consistent with vascular congestion.Note that there are no secondary findings for intestinal ischemia (no bowel dilatation, submucosal enhancement, wall thickening or free fluid) suggesting a still viable small bowel (confirmed intraoperatively)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2481&req=5

MPX2481_synpic23901: Mesentric root rotation about SMA axis with "whirl sign". Note engorgement of vessels and a "misty" surrounding fat consistent with vascular congestion.Note that there are no secondary findings for intestinal ischemia (no bowel dilatation, submucosal enhancement, wall thickening or free fluid) suggesting a still viable small bowel (confirmed intraoperatively)

View Article: MedPix Image - MedPix Case

Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Transmesenteric internal hernia, small bowel volvulus

History: 27 y/o woman with sudden onset of periumbilical abdominal pain relieved only by "bending forward". Previous surgery - gastric bypass 2 years ago.

Findings: Early studies demonstrate an internal transmesenteric small bowel hernia without volvulus or ischemia. Recent study demonstrate the "whirl" sign - indicating twisting of the bowel and, hence, volvulus. No evidence of intestinal ischemia or necrosis on CT (no submucosal enhancement, bowel wall thickening, free fluid or pneumatosis intestinalis).

Ddx: Clinical difeerential diagnosis: <li> Acute appendicitis <li> Acute cholecystitis <li> Mesenteric ischemia <li> Volvulus Imaging findings are diagnostic.

Dxhow: Surgery

Exam: Severe periumbilical pain, peritoneal signs. Unable to tolerate oral contrast.

No MeSH data available.