PMC4515260_01
A radiograph shows the dilated small bowel in the upper quadrant.
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An abdominal radiograph showed the air-fluid levels in the upper quadrant with no free air under the dome of the diaphragm (Figure 1).
An axial computed tomography scan shows an encapsulated cluster of dilated small bowel loops (arrow) occupying the upper quadrant. A small bowel loop is ascending the left colic artery (arrowhead).
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An enhanced CT scan of the abdomen showed clustered encapsulated and dilated small bowel loops predominantly in the middle abdomen (Figures 2(a) and 2(b)).
A gastrointestinal series with barium contrast showing dilated loops of the small bowel in the upper quadrant, delay of contrast, or the point of obstruction (arrow).
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On Gastrografin contrast examination using double balloon-assisted endoscopy, he was found to have an incomplete stricture (Figure 3).
Operative findings. (a) Illustration. (b) The ileum is herniated through the mesenteric defect. (c) The small intestine is pulled out through the mesenteric defect. (d) Closure of the mesenteric defect.
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Intraoperatively, we found internal herniation of the small intestine loop through a defect in the transverse mesocolon, without any strangulation of the small intestine (Figure 4(a)). The herniated small intestine could be loosened and retracted back through the hernia (Figure 4(b)). The mesenteric anterior membrane formed the hernial sac (Figure 4(c)). The defect was sutured by using the anterior and posterior mesenteric membranes (Figure 4(d)).