Closed Loop Obstruction from Epiploic Appendage Adhesion Mimicking Pericecal Internal Hernia

Area of Science:

• Gastroenterology
• Abdominal Imaging
• Surgical Anatomy

Background:

• Internal hernias, though uncommon (0.2-0.9% of bowel obstructions), are increasingly recognized due to advanced surgical techniques like Roux-en-Y.
• These hernias involve visceral displacement through mesenteric or peritoneal defects, presenting primarily as acute bowel obstruction.

Observation:

• A case is presented where an adhesion of a transverse colon epiploic appendage to the ascending colon mesentery mimicked a pericecal internal hernia.
• This adhesion led to a closed-loop obstruction, highlighting a non-classical cause of internal hernia presentation.

Findings:

• Radiologists must recognize imaging findings of closed-loop obstruction in patients with a history of abdominal surgery.
• Adhesions can create internal hernias that resemble classic anatomical types, necessitating a broad differential diagnosis.

Implications:

• Increased awareness of adhesion-induced internal hernias is crucial for accurate diagnosis and timely patient management.
• Understanding these mimics improves diagnostic accuracy in patients presenting with bowel obstruction, especially post-operatively.