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Coronal view: arrow pointing to the dumb-bell transition point, where the proximal end of the closed loop small bowel herniated through a hole in the sigmoid epiploica.
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A few distended loops bulged into a paraumbilical hernia, which was 6 cm wide and not the cause of obstruction (Figs 1-3).
Coronal view: arrow pointing to the sharp transition point, where the distal end of the closed loop small bowel herniated through a hole in the sigmoid epiploica, demonstrating collapsed small bowel distally.
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A few distended loops bulged into a paraumbilical hernia, which was 6 cm wide and not the cause of obstruction (Figs 1-3).
Axial view: (A) and (B) arrows pointing to dilated small bowel from the closed loop obstruction. (C) and (D) arrows pointing to the transition point, where the small bowel is collapsed distally.
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A few distended loops bulged into a paraumbilical hernia, which was 6 cm wide and not the cause of obstruction (Figs 1-3).
Intra-operative photo with index finger placed in the hole of the sigmoid epiploica, the site where small bowel is herniating through.
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Through a midline incision, we eviscerated the dilated small bowel, and found a 40 cm long segment of small bowel herniating through a 2 cm defect of a sigmoid colonic epiploica (Figs 4 and 5).
Intra-operative photo, second view, with index finger placed in the hole of the sigmoid epiploica, demonstrating the closed loop of small bowel.
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Through a midline incision, we eviscerated the dilated small bowel, and found a 40 cm long segment of small bowel herniating through a 2 cm defect of a sigmoid colonic epiploica (Figs 4 and 5).
Intra-operative photo, status-post reduction of internal hernia. The defect in the sigmoid epiploica is approximately 2 cm in diameter.
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We used two Kelly clamps and 2-0 silk sutures to ligate and divide the sigmoid colon epiploica defect (Fig. 6).