Brogna Barbara, Urciuoli Luigi, Musto Lanfranco Aquilino, Iovine Lorenzo
Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, Avellino, Italy.
Department of Surgical Emergency, San Giuseppe Moscati Hospital, Avellino, Italy.
Radiol Case Rep. 2024 Jan 15;19(4):1356-1360. doi: 10.1016/j.radcr.2024.01.013. eCollection 2024 Apr.
Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.
小肠内疝（IHs）是小肠梗阻（SBO）和小肠绞窄的罕见原因，虽然在年轻人中更常见，但也可影响老年患者，且因其症状不具特异性而带来重大的诊断挑战。在大多数情况下，剖腹手术用于诊断小肠内疝。然而，多排螺旋计算机断层扫描（MDCT）通常是急诊情况下诊断小肠内疝的最佳影像学工具。一名83岁男性因急性腹痛和咖啡渣样呕吐物急诊入院。腹部MDCT显示在Treitz韧带水平近端空肠袢呈簇状外观，水溶性碘口服造影剂（泛影葡胺）未通过。还存在肠系膜水肿，肠壁最初受累。根据放射学报告怀疑为绞窄性左十二指肠旁疝（LPDH）。急诊剖腹手术发现约20 cm的近端空肠袢通过一个3 cm宽的疝孔（HO）沿Treitz韧带疝出，位于Landzert窝水平，在降结肠系膜汇合处，肠系膜下静脉（IMV）后方，确诊为LPDH。患者几天后康复出院。小肠内疝在文献中的报道不足，尤其是关于老年患者的病例，然而，它们可能是80岁以上人群小肠梗阻的一个原因。放射科医生和外科医生应了解小肠内疝的解剖学特征。
