2018 Volume 38 Issue 3 Pages 587-590
An 83-year-old male with no past surgical history of the abdomen sought medical attention at a nearby clinic with the chief complaint of abdominal pain, which lead to a diagnosis of bowel obstruction and was referred to our hospital. An abdominal CT scan revealed that the diameter of the small intestine narrowed acutely in the right lower abdominal quadrant. Considering all possible causes, an internal hernia was suspected to be the primary cause of the bowel obstruction and an emergency operation was performed. Upon laparotomy, a part of the ilium was found to be incarcerated within the para-ascending colic fossa. The herniated ilium was restored and the hernia sac was opened. After careful inspection there was no necrosis of the ilium, thus no excision was performed. A case of internal hernia in the paracolic gutter of the ascending colon is rare. CT imaging features are therefore little known and can make the diagnosis challenging. After taking prior reported cases as well as our case into account, we would like to report that there were two interesting features on CT imaging (1. Incarcerated intestine was shown at the lateral and dorsal area of ascending colon; and 2. Displacement of the ascending colon toward the medial aspect) which could be important for the diagnosis of this situation.
