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
. 2018 Oct 20;4(1):128.
doi: 10.1186/s40792-018-0535-z.

Diagnosis of incarcerated intramesosigmoid hernia aided by multiplanar reconstruction images of multidetector computed tomography: a case report

Hideki Nagano  1 , Takanori Goi  2 , Seiichi Taguchi  3 , Takayoshi Tsubaki  3 , Hidemasa Uematsu  4
Affiliations

Diagnosis of incarcerated intramesosigmoid hernia aided by multiplanar reconstruction images of multidetector computed tomography: a case report

Hideki Nagano et al. Surg Case Rep. .

Abstract

Background: Internal hernia is a rare cause of intestinal obstruction, and sigmoid mesocolon hernia is an extremely rare form of this condition. Among sigmoid mesocolon hernias, intramesosigmoid hernia is the least frequent subtype. We described a case of intramesosigmoid hernia through the orifice on the right leaf of the mesosigmoid with an incarcerated ileum of 6 cm in length without strangulation. This case was diagnosed by multidetector computed tomography with multiplanar reconstruction images and treated without resection of the small intestine in a 52-year-old man with characteristic diagnostic images.

Case presentation: A 52-year-old man suffering periumbilical cramping pain with sudden onset that had persisted for 1 week without recovery was referred to Fukui Katsuyama General Hospital. Multidetector computed tomography revealed small bowel obstruction, and an incarcerated short intestinal loop was revealed by sagittal slices of the multiplanar reconstruction images of the routine study of the left side of the pelvic space. Sagittal multiplanar reconstruction images also showed narrow belt-shaped fluid retention contacting the tip of the incarcerated short loop toward the cranial direction localized in the mesosigmoid. These findings indicated that the fluid and the herniated small bowel were wrapped together in the mesosigmoid, which was characteristic of intramesosigmoid hernia. The patient underwent laparotomy operation 2 days after admission. The ileum, which was approximately 75 cm proximal to the ileocecal junction and herniated into the mesosigmoid through the right leaf, was released without resection. The orifice located in the central part of the right leaf was oval shaped and measured less than 2 cm in diameter. The left leaf of the mesosigmoid was intact. The orifice of the right lobe was closed by suture. The patient showed an uneventful recovery.

Conclusion: We report an extremely rare case of incarcerated intramesosigmoid hernia that was diagnosed by multidetector computed tomography with multiplanar reconstruction images. The finding of narrow belt-shaped fluid retention contacting the tip of the incarcerated short intestinal loop is characteristic of intramesosigmoid hernia and will be useful for conclusively differentiating this disease from transmesosigmoid hernia. Although intramesosigmoid hernia is a rare cause of internal hernia, multidetector computed tomography and multiplanar reconstruction images can provide the characteristic findings and proved useful for the precise preoperative diagnosis and treatment of intramesosigmoid hernia.

Keywords: Intramesosigmoid hernia; MDCT; MPR; Sigmoid mesocolon hernia.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

All procedures used in this research were approved by the Ethical Committee of the Japan Community Health Care Organization.

Consent for publication

Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this Journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a MDCT showed small bowel obstruction and an incarcerated short loop of the intestine in the left pelvic space (arrows) on the left side of the collapsed sigmoid colon. S sigmoid colon. b Routine sagittal slices of MPR images showed two closely arranged portions of constriction (arrows) and the incarcerated section of the ileum. Narrow belt-shaped fluid retention (asterisk) was found to contact the incarcerated short loop toward the cranial direction, alongside the psoas muscle, indicating that the fluid and the incarcerated small bowel were wrapped together in the mesosigmoid, which was characteristic of IMSH
Fig. 2
Fig. 2
a Findings at laparotomy. The incarcerated small bowel was located approximately 75 cm proximal to the ileocecal junction, into the mesosigmoid through the right lobe (arrows). b The released ileum, measuring 6 cm in length, appeared viable and without severe color change (between the two arrows). c The incarcerated ileum was gently released. The orifice located at the central part of the right lobe of the mesosigmoid was oval shaped and measured less than 2 cm in diameter (arrows). The intact inside of the left lobe was seen through the orifice
Fig. 3
Fig. 3
Reconstructed oblique coronal image of MDCT showed the constricted part of the intestine and the converged mesentery (arrows), reflecting the position of the hernia orifice
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Hirashima K, Date K, Fujita K, Koide N, Kamuro A, Kato H, Fujita N. Strangulation of the small intestine caused by an intra-mesosigmoid hernia: a case report. Surg Case Rep. 2017;3:129. doi: 10.1186/s40792-017-0406-z. - DOI - PMC - PubMed
    1. Yang C., Kim D. Small bowel obstruction caused by sigmoid mesocolic hernia. Journal of Surgical Case Reports. 2014;2014(5):rju036–rju036. doi: 10.1093/jscr/rju036. - DOI - PMC - PubMed
    1. Nihon-Yanagi Y, Ooshiro M, Osamura A, Takagi R, Moriyama A, Urita T, Yoshida Y, Tanaka H, Sugishita T, Oshiro T, et al. Intersigmoid hernia: report of a case. Surg Today. 2010;40:171–175. doi: 10.1007/s00595-009-4010-0. - DOI - PubMed
    1. Kan H, Suzuki H, Takasaki H, Sasaki J, Furukawa K, Tajiri T. A case of an intramesosigmoid hernia. J Nippon Med Sch. 2009;76:13–18. doi: 10.1272/jnms.76.13. - DOI - PubMed
    1. Puri V, Bertellotti RP, Garg N, Fitzgibbons FJ., Jr Intramesosigmoid hernia: a rare type of congenital internal hernia. Hernia. 2007;11:463–465. doi: 10.1007/s10029-007-0219-2. - DOI - PubMed

LinkOut - more resources