Nam Le Duc, Trong Thai Khac, Thach Nguyen Van, Dung Le Duy, Mai Lam Sao, Hang Tong Thi Thu
Center of Diagnostic Imaging, Hospital108, Hanoi, Vietnam.
CATS Academy Boston, Massachusetts, USA.
Curr Med Imaging. 2025;21:e15734056359062. doi: 10.2174/0115734056359062250414074213.
A transverse mesocolic internal hernia is a phenomenon in which a small intestinal loop protrudes through the natural orifice in the transverse colon mesentery. This type of internal hernia in adults, although rare, is one of the causes of closed-loop intestinal obstruction, which requires prompt diagnosis and treatment.
We report two cases of transverse mesocolic internal hernia that were examined and subsequently treated at Hospital 108, Hanoi, Vietnam. Both patients (53 and 66 years old) had atypical clinical symptoms, mainly dull epigastric pain. Upon admission, they were initially examined clinically, followed by blood testing and chest and abdominal X-ray radiography. Diagnostic imaging was mainly based on subsequent Multidetector-Row Computed Tomography (MDCT). Laparoscopic/surgical release of the hernia and closure of the natural orifice in the transverse colon mesentery were performed. The clinical symptoms and laboratory and radiographic findings did not suggest a causal diagnosis. However, MDCT provided several images suggestive of an internal hernia, including a closed intestinal loop passing through the transverse colon mesentery and located posteriorly in the left abdominal cavity near the Treitz angle, displacement of the mesenteric vascular bundle, and colon displacement. These displacements were the causes of intestinal inflammation/obstruction. Additionally, laparoscopic/surgical results confirmed the MDCT diagnosis.
Thin-slice thickness, high spatial resolution, multiplanar reconstruction MDCT was effective for diagnosing transverse mesocolic internal hernia. In our two cases, MDCT helped determine the cause and assess the state of intestinal ischemia.
横结肠系膜内疝是指肠袢经横结肠系膜天然孔隙突出的一种现象。这种类型的成人内疝虽罕见，但却是闭袢性肠梗阻的病因之一，需要及时诊断和治疗。
我们报告两例横结肠系膜内疝病例，这两例患者在越南河内108医院接受检查并随后接受治疗。两名患者（分别为53岁和66岁）均有非典型临床症状，主要为上腹部隐痛。入院时，首先对他们进行了临床检查，随后进行了血液检测以及胸部和腹部X线摄影。诊断性成像主要基于后续的多排螺旋计算机断层扫描（MDCT）。实施了腹腔镜/手术松解疝并封闭横结肠系膜天然孔隙。临床症状以及实验室和影像学检查结果均未提示明确病因诊断。然而，MDCT提供了一些提示内疝的图像，包括一个闭袢肠袢穿过横结肠系膜并位于左腹腔靠近Treitz角的后方、肠系膜血管束移位以及结肠移位。这些移位是肠道炎症/梗阻的原因。此外，腹腔镜/手术结果证实了MDCT诊断。
薄层扫描、高空间分辨率、多平面重建的MDCT对诊断横结肠系膜内疝有效。在我们的两例病例中，MDCT有助于确定病因并评估肠道缺血状态。
