A True Congenital Internal Hernia Identified after a Motor Vehicle Collision

Internal hernias are classified as: d True-when the loops of the small intestine are displaced and covered by an extra sheet of peritoneum, which forms the hernia sac.2 d False-paraduodenal, through the foramen of Winslow, intersigmoidal, pericecal, paravesicular, transmesenteric, and retro-anastomotic.2 They account for approximately 0.5 to 4.1 per cent of acute intestinal obstructions.3 Despite their relative infrequent nature, internal hernias are quite dangerous, primarily due to complications including strangulation, intestinal gangrene, and subsequent septic shock.1 The preoperative diagnosis of an internal hernia is challenging. Computed tomography of the abdomen and pelvis is a helpful tool in this process.4 Findings on CT consistent with a congenital internal hernia include a sac-like mass of clustered small intestinal loops with converging engorged mesenteric vessels near its orifice, blurring of mesenteric vessels with localized fluid collection, dilated intestinewithin an apparent sac, intestinal wall thickening, hypoperfusion of dilated intestinal segments, ascites, and the radiographic small intestinal feces sign.4 Any of these findings in addition to an appropriate history and physical examination and a high index of suspicion will greatly aid the surgeon in diagnosing an internal hernia preoperatively.