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• W2913237312 abstract "Internal hernias are uncommon and often misdiagnosed because of non-specific symptoms. They occur when there is protrusion of an internal organ into a retroperitoneal fossa or a foramen leading to bowel obstruction. We report a case of asymptomatic internal hernia diagnosed incidentally during an emergency department visit. A 43-year-old Caucasian female with a history of cervical cancer status post partial hysterectomy presented to the emergency department for evaluation of pre-syncope. At the time of evaluation, she denied abdominal pain or distention and reported some nausea and vomiting that preceded her pre-syncope. A chest X-ray was obtained and showed massive gaseous dilation of the transverse colon up to 12 cm. A computed tomography of the abdomen was performed and revealed twisting of the mesenteric vessels, which was suspicious for an internal hernia. Also, a portion of the ascending colon looked entrapped within the suspected internal hernia and the transverse colon was dilated up to 13 cm. The patient was evaluated by the surgical team who recommended surgical correction and a possible colectomy, the patient refused any surgical intervention because she was asymptomatic and was discharged home. Internal hernias account for 0.6% to 5.8% of all intestinal obstructions. When a loop of bowel herniates through a mesenteric defect, it carries a high risk of strangulation and incarceration. The mesenteric defect can occur in seven different locations in the abdominal cavity accounting for the different types of internal hernias. The defect can be congenital or acquired secondary to trauma, surgical intervention, and vascular or inflammatory diseases. While some patients with internal hernias are asymptomatic, others have nonspecific symptoms such as chronic dyspepsia or intermittent colicky abdominal pain that renders the diagnosis difficult. Surgical intervention is the treatment of choice in symptomatic and asymptomatic cases. This reduces the risk of urgent surgery needed for incarcerated hernias. Among internal hernia cases reported in the literature, this is the first to describe a massive dilation of the transverse colon up to 13 cm without any symptoms. It is important to recognize that internal hernias have nonspecific symptoms and may be asymptomatic for decades, which makes the initial diagnosis challenging. Patients may refuse surgery since they are asymptomatic however surgical correction is necessary to prevent the morbidity of the disease.Figure: Chest X Ray showing colonic dilation.Figure: CT abdomen revealing colonic dilation.Figure: CT abdomen revealing colonic dilation." @default.
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• W2913237312 date "2017-10-01" @default.
• W2913237312 modified "2023-09-25" @default.
• W2913237312 title "An Unexpected Massive Colonic Dilation on a Chest X-ray" @default.
• W2913237312 doi "https://doi.org/10.14309/00000434-201710001-01476" @default.
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