Abstract
An 86-year-old woman with no previous history of undergoing laparotomy visited a hospital because of nausea and abdominal pain and was referred to our hospital for further exploration and treatment because bowel obstruction was diagnosed from a plain abdominal X-ray film. An abdominal plain CT scan revealed dilatation of the small intestine associated with ascites, but no obvious causes of the intestinal obstruction were shown. Abdominal distention was noted, but the abdomen was soft and there was no rebound tenderness. Accordingly the patient was admitted to the department of gastroenterological medicine in our hospital and conservative therapy was started by placing a long tube for intermittent sustained aspiration. However, no symptomatic remission could be gained, and another CT scan done on the 3rd hospital day disclosed no changes in the small bowel dilatation and increased ascites. We determined that the conservative therapy might be ineffective and performed emergency operation. When the abdomen was opened, we saw a defect about 3 cm in diameter in the mesentery of transverse colon locating on the right side of the Treitz ligament, through which an about 40 cm-long portion of the jejunum had incarcerated into the omental bursa at about 80 cm distant from the Treitz ligament. Necrosis was absent in the small intestine and so the operation was completed after reduction of the herniated intestine followed by closure of the defect by sutures. The patient's postoperative course was uneventful.
Retrospective review of these CT scans after the operation demonstrated the presence of hernia opening. This case would thus be one in which we could diagnose the disease preoperatively by using CT.
