Contributor: Adam Barkin, MD

Educational Pearls:

Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions
Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis
Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension
Increased risk in patients with gastric bypass, liver transplant, or laparascopic surgery
CT is very >90% sensitivity and specific in diagnosing SBO due to internal hernia
- Mesenteric swirl is a classic radiology finding
Treatment with immediate surgical consultation for possible OR bowel decompression
Start on broad spectrum antibiotics with any signs of sepsis

References

Lanzetta MM, Masserelli A, Addeo G, et al. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. Acta Biomed. 2019;90(5-S):20-37. Published 2019 Apr 24. doi:10.23750/abm.v90i5-S.8344

Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703-717. doi:10.2214/AJR.05.0644

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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