Abdominal hernias: from the outside to the inside

Poster No.: C-0691

Congress: ECR 2018
Type: Educational Exhibit
Authors: C. Sousa, J. Rebelo, A. Moreira, I. Portugal, R. Cunha; Porto/PT
Keywords: Abdomen, Hematologic, CT, Diagnostic procedure, Hernia
DOI: 10.1594/ecr2018/C-0691

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Page 1 of 38
Learning objectives

To review and distinguish the imagiological findings of external, internal, and

diaphragmatic hernias on the basis of their localization, with special focus on their atypical
and less common appearances.

To describe the potential mimickers and complications of the abdominal hernias.

To review potential postoperative complications and failure of surgical repair of abdominal

hernias.

Page 2 of 38
Background

Abdominal hernias are among the most common surgical problems, and a leading cause
of abdominal pain and intestinal obstruction. The main types of abdominal hernias are
external hernias, which involve protrusion of abdominal contents through a defect in
the abdominal wall; internal hernias, with protrusion of viscera through the peritoneum,
mesentery or a compartment in the abdominal cavity; and diaphragmatic hernias,
involving protrusion of abdominal contents into the chest.

Page 3 of 38
Findings and procedure details

ABDOMINAL WALL HERNIAS

Umbilical Hernias

Umbilical hernias are the most common type of ventral hernias and are usually
asymptomatic. They are habitually congenital, resulting from incomplete closure of the
abdominal wall after ligation of the umbilical cord. In adults they appear generally in
context of multiple pregnancies, ascites, obesity, abdominal masses or chronic increased
abdominal pressure. The herniated sac usually contains the greater omentum or bowel
loops, that can be incarcerated, causing symptoms of intestinal obstruction and local
tenderness (Fig.1).

Fig. 1: Axial unenhanced CT scan shows an umbilical hernia. Thickening and edema
of the fat planes suggesting acute complications (inflammation/ischemia).

Page 4 of 38
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Paraumbilical Hernias

Paraumbilical hernias arise in the midline near the umbilicus. They are commonly
associated with diastasis of the rectus abdominis muscles (Fig. 2).

Fig. 2: Axial CT scans show paraumbilical hernias (arrows). They are usually
associated with diastasis of the rectus abdominis muscles.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Hypogastric Hernias

Hypogastric hernias arise below the umbilicus in linea alba (Fig. 3).

Page 5 of 38
Fig. 3: Axial CT scan depict an uncomplicated hypogastric hernia containing bowel
loops.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Epigastric Hernias

Epigastric hernias arise in linea alba between the umbilicus and the xyphoid process.
When associated with pain, it can simulate peptic ulcer or gallbladder illness (Fig. 4).

Page 6 of 38
Fig. 4: Axial unenhanced (A) and sagittal enhanced CT (B) show epigastric hernias
(arrows) with only a portion of the bowel wall in the hernial sac (Richter´s hernia).
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Spigelian Hernias

Spigelian hernias are related to a congenital weakness in the posterior layer of the
transverse fascia, near the junction of semilunar line and arcuate line. These hernias are
uncommon and the diagnosis can be difficult, because they are often interparietal and
extend between muscular or fascial layers of the anterior abdominal wall (Fig. 5).

Page 7 of 38
Fig. 5: (A) Axial and (B) sagittal enhanced CT scans depicting a right Spigelian hernia.
The hernial sac contains portion of the sigmoid colon without signs of complications.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Lumbar Hernias

Lumbar hernias are located below the 12th rib and above the iliac crest. They occur
related to defects in the lumbar muscles or the posterior fascia, usually secondary to
surgery (e.g. kidney surgeries) or trauma.

- Superior Lumbar Hernias (Grynfelt-Lesshaft Hernias)

Superior lumbar hernias arise in the superior lumbar triangle bordered anteriorly by the
internal oblique muscle, the 12th rib superiorly, and the erector spinal muscle posteriorly
(Fig. 6).

Page 8 of 38
Fig. 6: Axial and coronal CT scan showing a right superior lumbar hernia containing
the colon's hepatic flexure. The patient was asymptomatic and no signs of complication
were seen.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

- Inferior Lumbar Hernias (Petit Hernias)

Inferior lumbar hernias occur through the inferior lumbar triangle bordered anteriorly
by the external oblique muscle, the 12th rib superiorly, and the erector spinal muscle
posteriorly.

Incisional Hernias

Incisional hernias occur through defects related to prior abdominal surgeries (Fig. 7, Fig.
8). They usually represent a delayed complication. Symptoms are present within the first
4 months after surgery.

The risk of an incisional hernia is higher in vertical incisions and after wound infections
with subsequent dehiscence. Predisposing factors include old age, malnutrition,
malignancy, pregnancy, ascites, chronic pulmonary diseases and obesity. Paraestomal
Hernias are considered a subtype of incisional hernia. They occur adjacent to a stoma
and are particularly difficult to detect at physical examination (Fig. 9).

Page 9 of 38
Fig. 7: Incisional hernia containing small bowel loop. There were no signs of
incarceration and the hernia was manually reducible.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Fig. 8: Axial and sagittal enhanced CT scans show a large defect on the abdominal
wall at the location of a previous surgery. The herniated sac contains a segment of the
transverse colon. No signs of acute complications were seen.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Page 10 of 38
Fig. 9: Peritoneal dialysis catheter related hernia (arrows).
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Groin hernias

-Inguinal Hernias

Inguinal hernias represent the most common type of abdominal hernia, more commonly
found in males. They can be distinguished by its relation with the epigastric vessels.

Direct hernias occur medial to the inferior epigastric vessels, and are usually acquired,
resulting from a weakness of the transversal fascia in Hesselbach's triangle. The
peritoneal sac protrudes through the inguinal canal and emerges at the external inguinal
ring (Fig. 10). The inguinal canal is usually compressed or displaced ("lateral crescent
sign").

Page 11 of 38
Fig. 10: Right inguinal hernia (arrow). Direct type.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Indirect hernias are more common than direct hernias, and the majority occurs in men
due to persistence of the process vaginalis during testicular descent (Fig. 11). They
arise lateral and superior to the inferior epigastric vessels and lateral to the Hesselbach's
triangle. In men, they enter the canal anterior to the spermatic cord and may extend to
the external inguinal ring into scrotum (Fig. 12). In women, they tend to follow the round
ligament into the labia majora.

Page 12 of 38
Fig. 11: Left inguinal hernia (arrow). Indirect type.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Fig. 12: Inguinoscrotal hernia, with herniation of the bladder through the scrotum.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Femoral hernias arise inferior of the course of the inferior epigastric vessels and
medial to the common femoral vein (Fig. 13). They are more frequent in women. Acute

Page 13 of 38
complications are more frequently than in inguinal hernias due to the narrower orifice.
They regularly compress the femoral vein.

Fig. 13: Right femoral hernia, containing ascitic fluid.

References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Other Hernias

Obturador Hernias are rare, primarily found on women with previous pregnancy or
significant weight loss. The peritoneal sac and its contents protude between the external
obturador and pectineal muscles (Fig. 14).

Page 14 of 38
Fig. 14: Obturator hernia. Axial and coronal CT scans show a small right obturator
hernia (arrows).
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Traumatic Hernias are related to high energy traumas, usually requiring surgical
correction. They are most common in locations with relative anatomic weakness, the
lumbar region and the lower abdomen.

Interparietal Hernias or interstitial hernias consists of a herniation that not exit the
subcutaneous tissue, usually located in the fascial planes between the abdominal wall
muscles (Fig. 15).

Page 15 of 38
Fig. 15: Interparietal hernia. Axial and sagittal CT scans demonstrating a right
posterior interparietal hernia containing only peritoneal fat.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

COMPLICATIONS

Incarceration refers to an irreducible hernia due to narrowing of hernia orifice. Early

detection is important to prevent complications such as obstruction, inflammation or
ischemia. The presence of free fluid in the herniated sac, bowel wall thickening or luminal
dilatation suggests incarceration (Fig. 16).

Fig. 16: Incarcerated umbilical hernia in a 66 years-old patient with acute abdominal
pain. Axial enhanced CT scans shows an umbilical hernia incarcerated with ascitic
fluid.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Bowel obstruction

Abdominal wall hernias are the second leading cause of small bowel obstruction. Dilated
bowel proximal to the hernia and normal or reduced caliber of the bowel distal to
the obstruction are the key imagiologic features (Fig. 17). Other ancillary sign include
fecalization of small bowel contents proximal to the obstruction. Colonic obstruction
caused by an abdominal wall hernia is rare.

Page 16 of 38
Fig. 17: Small bowel obstruction. 72 years-old patient presented with an inguinoscrotal
mass and acute abdominal pain. Axial enhanced CT scans show herniation of small
bowel loops through the inguinal canal (yellow arrow), causing intestinal obstruction
with dilated loops (green arrow).
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

DIAPHRAGMATIC HERNIAS

Diaphragmatic hernias are defined as either congenital or acquired defects in the

diaphragm.

Congenital

There are two main types of congenital diaphragmatic hernia that usually occur on the
left side (80%) of the diaphragm:

- Bochdalek hernia: most common (95%), located posterolaterally and usually present
in infancy (Fig. 18).

- Morgagni hernia: smaller, anterior and presents later in life, through the sternocostal
angles (Fig. 19).

Acquired

There are a variety of aetiologies for acquired diaphragmatic hernias that usually occur
in adulthood, namely traumatic diaphragmatic rupture, hiatus hernia (Fig. 20), and
iatrogenic.

Page 17 of 38
Fig. 18: Left Bochdalek hernia (arrows).
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Fig. 19: Right Morgagni hernia (arrows).

References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Page 18 of 38
Fig. 20: Bulky hiatal hernia, containing transverse colon, stomach and greater
omentum.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

INTERNAL HERNIAS

PARADUODENAL HERNIAS

Left Paraduodenal Hernias are entrapments of the small intestine into the fossa of
Landzert, an unusual congenital peritoneal fossa behind the descending mesocolon that
is present in 2% of individuals. At CT, intestinal loops with a saclike appearance are seen
in the left anterior pararenal space. The inferior mesenteric vein and ascending left colic
artery are landmarks situated at the anteromedial edge of the fossa of Landzert. In the
event of a left paraduodenal hernia, the inferior mesenteric vein is observed anterior and
medial to the hernia orifice and entrapped intestine.

Right Paraduodenal Hernia usually involves the fossa of Waldeyer and occur most
frequently in the setting of a nonrotated small intestine. The fossa of Waldeyer is located
inferior to the third portion of the duodenum, behind the root of the small bowel mesentery,
and extends rightward and downward into the ascending mesocolon. Landmarks for
the hernia orifice at multidetector CT are the superior mesenteric artery and superior
mesenteric vein that run along the anteromedial free edge of the fossa (Fig. 21).

Page 19 of 38
Fig. 21: Right paraduodenal hernia in a 53-year-old female with sudden abdominal
pain - Contrast-enhanced CT scan shows a saclike fluid-filled bowell loops and the
encapsulated bowel loops herniated through the fossa of Waldeyer. The superior
mesenteric artery is displaced anteriorly.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

SMALL BOWEL MESENTERY-RELATED HERNIA

Transmesenteric Hernia is the most common one, and affects both peritoneal layers.
Although displacement of the main mesenteric trunk to the right has been reported as
a useful CT finding, this subtype does not show a saclike appearance and has no key
vessels, making it difficult to distinguish from other causes of small-howell obstruction
(Fig. 22). Furthermore, transmesenteric hernias tend to be complicated by volvulus.

Page 20 of 38
Fig. 22: Transmesenteric hernia in a 67-year-old female - Contrast-enhanced CT scan
shows dilated and fluid-filled small bowel loops and crowded and stretched vessels.
No sac is observed. On surgery it was demonstrated incarcerated intestine through a
defect in the mesentery of the ileum.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

Intramesenteric Hernias are less frequent and predominantly occur in children. Either
one of the two peritoneal layers can be affected. CT findings include a cluster of small
bowel encapsulated within a hernia sac and displacement of the superior mesenteric
artery and superior mesenteric vein.

GREATER OMENTUM-RELATED HERNIA

Transomental hernia are a closed-loop intestine without a saclike appearance, located

in the most anterior portion of the peritoneal cavity, because the direction of a
transomental hernia is usually posterior to anterior (Fig. 23). Omental branches of the left
and right gastro-omental vessels are landmarks that run inside the greater momentum
and run vertically around the hernia orifice.

Page 21 of 38
Fig. 23: Transomental hernia in a 51-year-old man with acute diffuse abdominal pain.
Contrast-enhanced CT scan shows dilated and fluid-filled closed bowel loops and
engorged and crowded mesenteric vessels at the hernial orifice.
References: Department of Radiology, Centro Hospitalar São João, Faculdade de
Medicina da Universidade do Porto - Porto/PT

FORAMEN OF WINSLOW HERNIAS

Foramen of Winslow hernias account for 8% and are the most common type of lesser sac
hernia. They are herniations in which the viscera enter the lesser sac through the foramen
of Winslow and are congenital. The most commonly involved viscus is the small bowel,
but the terminal ileum, cecum, ascending colon, transverse colon, and gallbladder can
also be involved at a rate about 25%. The presence of herniated viscera in the lesser sac,
in a "beak" shape pointing toward the foramen of Winslow, is observed at multidetector
CT. When the small or large intestine is involved, the presence of mesenteric vessels
between the inferior vena cava and portal vein is also diagnostic.

TRANSVERSE MESOCOLON-RELATED HERNIA

Page 22 of 38
Transverse mesocolon-related hernia are herniations through or into an abnormal defect
in the transverse mesocolon, in which the herniated viscera displace the transverse colon
anteriorly and inferiorly. They are uncommon without a history of surgery, however an
increasing number of cases have been reported after Roux-en-Y anastomosis surgery.
There are two subtypes of transverse mesocolon-related hernias according to the degree
of the defect: (a) transmesenteric, if a complete defect in the transverse mesocolon is
present; or (b) intramesentbric, if the defect is only in the posterior peritoneal layer of
the transverse mesocolon, and the herniated viscera are trapped within the transverse
mesocolon.

PERICECAL HERNIA

Pericecal hernias account for 13% of all internal hernias. They are herniations into an
unusual recess near the cecum, including the superior ileocecal recess, inferior ileocecal
recess, retrocecal recess, and paracolic sulci. In addition to these congenital recesses,
acquired conditions such as adhesion may cause a pericecal hernia. CT findings of
pericecal hernia are characteristic. A saclike appearance is seen, and the hernia sac
displaces the cecum and ascending colon anteriorly or medially.

SIGMOID MESOCOLON-RELATED HERNIA

Sigmoid mesocolon-related hernias account for 6% of all internal hernias and

can be classified into three subtypes: transmesosigmoid, intramesosigmoid, and
intersigmoid.

Transmesosigmoid and intramesosigmoid hernias are herniations through or into an

abnormal defect in the sigmoid mesocolon. A transmesosigmoid hernia is a herniation
through a complete defect in both of the peritoneal layers of the sigmoid mesocolon. An
intramesosigmoid hernia is a herniation into an abnormal defect in only one peritoneal
layer, making the herniated viscera trapped in the sigmoid mesocolon. On the other hand,
an intersigmoid hernia involves the intersigmoid fossa, a congenital retroperitoneal
fossa present in 70% of individuals, located just above and behind the apex of the root
of the sigmoid mesocolon.

At CT, the hernia orifice can be observed between the sigmoid colon and the left psoas
major muscle in all three subtypes. The key to diagnosis of a transmesosigmoid hernia
is absence of a saclike appearance, while intramesosigmoid and intersigmoid hernias
show a saclike appearance.

Page 23 of 38
PELVIC INTERNAL HERNIA

Broad Ligament Hernia is a herniation through or into an abnormal opening in the broad
ligament of the uterus and account for 4-5% of all internal hernias. 80% of broad ligament
defects occur in multiparous women. The most common hernia content is the small
intestine. They can be classified into two subtypes, according to the degree of the defect.
The fenestra type is the most common and it is a herniation through both peritoneal layers
of the broad ligament. No hernia sac is present, and the herniated intestine is located
lateral to the uterus in the pelvic cavity. The pouch type is a herniation into a defect in
only one of the two peritoneal layers of the broad ligament and manifests as herniated
viscera within a sac trapped in the parametrium.

ROUX-EN-Y ANASTOMOSIS-RELATED HERNIA

Reconstruction of a Roux-en-Y anastomosis is one of the common and increasing

procedures in gastric surgeries. Internal hernia is a major complication of this
anastomosis and results more commonly after laparoscopic gastric bypass surgery
than open surgery. Three subtypes of transmesenteric-type hernias can occur:
transmesocolic, jejunojejunostomy mesenteric, and Petersen hernias.

At CT, the anatomy in patients who have undergone Roux-en-Y gastric bypass
surgery is complex. In addition, Roux-en-Y anastomosis-related hernias without intestinal
obstruction are sometimes observed. CT signs that suggest this diagnosis are mesenteric
swirl, clustered small bowel loops, the "mushroom" sign (a mushroom-shaped mesenteric
root between the superior mesenteric artery and the distal mesenteric arterial branch),
the "hurricane eye" sign (distal tubular mesentery with surrounding small bowel loops),
a small bowel loop behind the superior mesenteric artery, abnormal position of the
jejunojejunostomy, and "weeping mesentery" (edematous mesentery with enlarged
lymph nodes).

Page 24 of 38
Images for this section:

Fig. 1: Axial unenhanced CT scan shows an umbilical hernia. Thickening and edema of
the fat planes suggesting acute complications (inflammation/ischemia).

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 2: Axial CT scans show paraumbilical hernias (arrows). They are usually associated
with diastasis of the rectus abdominis muscles.

Page 25 of 38
© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da
Universidade do Porto - Porto/PT

Fig. 3: Axial CT scan depict an uncomplicated hypogastric hernia containing bowel loops.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 4: Axial unenhanced (A) and sagittal enhanced CT (B) show epigastric hernias
(arrows) with only a portion of the bowel wall in the hernial sac (Richter´s hernia).

Page 26 of 38
© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da
Universidade do Porto - Porto/PT

Fig. 5: (A) Axial and (B) sagittal enhanced CT scans depicting a right Spigelian hernia.
The hernial sac contains portion of the sigmoid colon without signs of complications.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 6: Axial and coronal CT scan showing a right superior lumbar hernia containing the
colon's hepatic flexure. The patient was asymptomatic and no signs of complication were
seen.

Page 27 of 38
© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da
Universidade do Porto - Porto/PT

Fig. 7: Incisional hernia containing small bowel loop. There were no signs of incarceration
and the hernia was manually reducible.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Page 28 of 38
Fig. 8: Axial and sagittal enhanced CT scans show a large defect on the abdominal
wall at the location of a previous surgery. The herniated sac contains a segment of the
transverse colon. No signs of acute complications were seen.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 9: Peritoneal dialysis catheter related hernia (arrows).

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 10: Right inguinal hernia (arrow). Direct type.

Page 29 of 38
© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da
Universidade do Porto - Porto/PT

Fig. 11: Left inguinal hernia (arrow). Indirect type.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 12: Inguinoscrotal hernia, with herniation of the bladder through the scrotum.

Page 30 of 38
© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da
Universidade do Porto - Porto/PT

Fig. 13: Right femoral hernia, containing ascitic fluid.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 14: Obturator hernia. Axial and coronal CT scans show a small right obturator hernia
(arrows).

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Page 31 of 38
Fig. 15: Interparietal hernia. Axial and sagittal CT scans demonstrating a right posterior
interparietal hernia containing only peritoneal fat.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 16: Incarcerated umbilical hernia in a 66 years-old patient with acute abdominal pain.
Axial enhanced CT scans shows an umbilical hernia incarcerated with ascitic fluid.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Page 32 of 38
Fig. 17: Small bowel obstruction. 72 years-old patient presented with an inguinoscrotal
mass and acute abdominal pain. Axial enhanced CT scans show herniation of small
bowel loops through the inguinal canal (yellow arrow), causing intestinal obstruction with
dilated loops (green arrow).

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 18: Left Bochdalek hernia (arrows).

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Page 33 of 38
Fig. 19: Right Morgagni hernia (arrows).

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 20: Bulky hiatal hernia, containing transverse colon, stomach and greater omentum.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Page 34 of 38
Fig. 21: Right paraduodenal hernia in a 53-year-old female with sudden abdominal
pain - Contrast-enhanced CT scan shows a saclike fluid-filled bowell loops and the
encapsulated bowel loops herniated through the fossa of Waldeyer. The superior
mesenteric artery is displaced anteriorly.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 22: Transmesenteric hernia in a 67-year-old female - Contrast-enhanced CT scan

shows dilated and fluid-filled small bowel loops and crowded and stretched vessels. No

Page 35 of 38
sac is observed. On surgery it was demonstrated incarcerated intestine through a defect
in the mesentery of the ileum.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Fig. 23: Transomental hernia in a 51-year-old man with acute diffuse abdominal pain.
Contrast-enhanced CT scan shows dilated and fluid-filled closed bowel loops and
engorged and crowded mesenteric vessels at the hernial orifice.

© Department of Radiology, Centro Hospitalar São João, Faculdade de Medicina da

Universidade do Porto - Porto/PT

Page 36 of 38
Conclusion

Abdominal hernias are a common clinical problem. Familiarity with the appearances of
various types of abdominal hernias allows confident diagnosis of these entities and their
complications.

Page 37 of 38
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