Pericecal herniation of sigmoid colon diagnosed by computed tomography: Two case reports

Abstract

Introduction: Computed tomography (CT) plays an important role in diagnosing specific types of internal hernias and their complications. In particular, pericecal hernia of the sigmoid colon has never been reported in the English literature.

Case presentation: The first patient was a 46-year-old female presented to our institution due to acute abdominal pain. The second patient was a 55-year-old male presented to our institution with continuous diarrhea. The patient underwent colonoscopy for further evaluation. However, even with sufficient air insufflation and repetitive maneuvers, the colonoscope could not proceed beyond the narrowed level of the sigmoid colon. In both cases, contrast-enhanced abdominal CT was done and a herniated loop of sigmoid colon was noted in the posterolateral aspect of the cecum and ascending colon. Thus, a diagnosis of pericecal herniation of the sigmoid colon was established.

Conclusion: This case study indicates that radiologic examination can be helpful in detecting pericecal herniation of the sigmoid colon.

Figure 1

(A) Supine abdominal radiography shows a loop of colon (asterisk), identified by the colonic haustration, in right upper quadrant of abdomen, medially displacing the ascending colon and cecum (arrowheads). (B, C) On axial and (D) coronal reformatted images of the contrast enhanced abdominal computed tomography, sigmoid colon (SC) is herniated at posterolateral aspect of the cecum (Ce) and ascending colon (AC), with increased density of the sigmoid mesocolon (white arrow) due to congestion.

Figure 2

(A) Obstruction of the sigmoid colon due to twisting and narrowing of the colonic lumen (black arrow) was noted on colonoscopy, and the colonoscope could no longer proceed. (B) On axial and (C, D) coronal reformatted images of contrast-enhanced abdominal computed tomography (CT), herniated sigmoid colon (SC) is located at the posterolateral aspect of the cecum (Ce) and ascending colon (AC). No signs of complications such as strangulation or obstruction were noted on CT.