Relative frequency of internal hernias Historical data (2) Bariatric surgical patients (5) Paraduodenal 53 Trans-mesocolon 46 Pericecal
13 J-J (trans-mesenteric) 41 Foramen of Winslow 8 Petersen 13 Trans-mesenteric 8 Intersigmoid 6 Post-surgical 5 Table 2.
Contrast-enhanced tomography (CT) scan of the abdomen revealed concentric and diffuse thickening of the cecum wall and the wall of appendix was edematous and mesenteric several lenf nodes and heterogeneous density were detected in pericecal
region (Figure 1).
Pelvic magnetic resonance imaging (MRI) findings indicated a small-sized uterus and a pericecal
cystic lesion, while the adnexal structure imaging was unclear.
The CT findings of appendicitis include dilatation of appendix (>6 mm in diameter), heterogeneity of periappendiceal and pericecal
fat as a sign of inflammation, and intraluminal appendicolith and formation of phlegmon or abscess (1) (Figure 1).
CT scan of the abdomen and pelvis showed pericecal
inflammatory stranding without pneumatosis concerning cecal typhlitis as well as an "apple-core mass" of the ascending colon near the hepatic flexure concerning colon cancer (Figure 1).
There are multiple types of internal hernia, including paraduodenal, Foramen of Winslow, sigmoid mesocolon, pericecal
, transmesenteric, transomental, supravesical, and pelvic.
In addition, the imaging showed peritoneal carcinomatosis, multiple ill-defined hypoattenuating lesions in the liver, and enlarged and hypoattenuating pericecal
iliac lymph nodes.
Abdominal computed tomography (CT) revealed pericecal
inflammation and a residual appendiceal stump (Figure 1) in his right iliac fossa.
In relation to the location, they can be distinguished in paraduodenal, through Winslow foramen, intersigmoid, pericecal
, transmesenteric, and retroanastomotic; in our personal data 48 out of 84 patients that present to our observation had right or left paraduodenal type (57%) so in line with literature this kind of hernias is the most frequent .
El paciente fue sometido a apendicectomia clasica con abordaje Rockey Davis, bajo tecnica de Pouchet, durante la cual se observo un proceso inflamatorio del apendice vermiforme gangrenosa con trayecto postileal adherido en un 70% a la serosa del borde antimesenterico del ileon distal con microperforaciones en la punta y con base sana, asociado a escaso liquido inflamatorio pericecal
Air-fluid levels were observed on direct graphy and pericecal
collection was observed in the right lower quadrant on tomography.