Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Apr;24(2):171-4.
doi: 10.4103/0971-3026.134407.

Stretched bowel sign in combined transmesocolic and transomental internal hernia: A case report and review of literature

Nischal G Kundaragi  1 , Shanmugam Vinayagam  1 , Srinivasa Mudali  1
Affiliations
Case Reports

Stretched bowel sign in combined transmesocolic and transomental internal hernia: A case report and review of literature

Nischal G Kundaragi et al. Indian J Radiol Imaging. 2014 Apr.

Abstract

Transomental and transmesenteric hernias are rare types of internal hernia, with a reported frequency of upto 4% and 8%, respectively. Combined transomental and transmesocolic hernia is even rare. Only in a few types of internal hernia, the dilated small bowel loops will be seen extending from the antero-superior aspect of the distal stomach and cause stretching effect over the adjacent bowel loops with increase in the size of the herniated bowel segment or intestinal obstruction. We report a rare case of idiopathic combined transomental (across the lesser omentum) and transmesocolic internal hernia with "stretched bowel sign," its diagrammatic representations, and review of literature.

Keywords: Internal hernia; non-contrast enhanced computed tomography study; stretched bowel; transmesocolic; transomental.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1(A-C)
Figure 1(A-C)
CT scan axial and oblique coronal images show elongated and stretched down stomach (star-shaped markers) and transverse colon (white open arrow) with two collapsed small bowel loops with beaking (black arrows in A) seen antero-superior to the antral part of the stomach. Dilated small bowel loops are seen right lateral and inferior to the stomach and the transverse colon. Mild free fluid in between the bowel loops and mild distal stomach wall thickening (congestive edema) are also noted
Figure 2
Figure 2
Intraoperative image showing herniated small bowel loops (black arrows) seen entering the peritoneal cavity from the superior aspect of the antrum of the stomach (star-shaped marker). Transverse colon is seen just below the stomach (open arrow)
Figure 3(A-C)
Figure 3(A-C)
Diagram representing combined transmesocolic and transomental (through lesser omentum) hernia. A shows the herniated bowel loops seen ventral to the distal stomach, and C represents the stretched down stomach and the transverse colon with increasing intestinal obstruction. B represents the initial findings of the same hernia
Figure 4
Figure 4
Diagram showing double omental hernia with small bowel loops herniating from greater and lesser omental defects with prolapsed loops seen anterior to the distal stomach; it may present as epigastric lump
See this image and copyright information in PMC

References

    1. Takeyama N, Gokan T, Ohgiya Y, Satoh S, Hashizume T, Hataya K, et al. CT of internal hernias. Radiographics. 2005;25:997–1015. - PubMed
    1. Chou CK, Mak CW, Wu RH, Chang JM. Combined transmesocolic-transomental internal hernia. AJR Am J Roentgenol. 2005;184:1532–4. - PubMed
    1. Stern LE, Warner BW. Congenital Internal Abdominal hernias: Incidence and Management. In: Fitzgibbons RJ Jr, Greenburg AG, editors. Nyhus and Condon's hernia. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 461.
    1. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: Radiographic and clinical findings. AJR Am J Roentgenol. 2006;186:703–17. - PubMed
    1. Meyers MA, Charnsangavej C, Oliphant M. 6th ed. New York, NY: Springer; 2011. Meyers’ Dynamic Radiology of the Abdomen Normal and Pathological Anatomy; pp. 398–400.

Publication types