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Internal hernia

Last updated: March 31, 2020

Summary

An internal hernia is the protrusion of visceral contents through a congenital or acquired defect in the peritoneum or mesentery within the abdominal cavity. Internal hernias have an incidence of < 1% and are significantly less common than external hernias. Patients with a history of Roux-en-Y gastric bypass or liver transplant are especially at risk of internal hernia formation. Small bowel loops are the most common content of an internal hernia. For this reason, the typical clinical presentation is that of a mechanical small bowel obstruction (i.e., colicky abdominal pain, vomiting, constipation, abdominal distention). Contrast-enhanced CT scan is the imaging modality of choice in most cases, but surgical intervention is often required for definitive diagnosis and treatment. Incarceration or strangulation of internal hernias carries a high mortality rate; rapid diagnosis and surgical repair is therefore imperative.

Epidemiology

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Internal hernias are a protrusion of visceral contents through a defect in the peritoneum or the mesentery :

References:[2]

Clinical features

References:[1][3]

Diagnostics

The diagnosis of an internal hernia is confirmed by laparoscopy in the majority of cases.
References:[3]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

If an internal hernia leads to incarceration, the mortality rate is ∼ 80%!
References:[2]

References

  1. Yeo CJ, Matthews JB, McFadden DW, Pemberton JH, Peters JH . Shackelford's Surgery of the Alimentary Tract. Elsevier Saunders ; 2012
  2. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006; 186 (3): p.703-717. doi: 10.2214/AJR.05.0644 . | Open in Read by QxMD
  3. Internal hernia. https://radiopaedia.org/articles/internal-hernia. Updated: February 14, 2017. Accessed: February 14, 2017.