J Korean Soc Radiol.  2012 Jun;66(6):539-542. 10.3348/jksr.2012.66.6.539.

Internal Hernia through a Peritoneal Defect of the Pouch of Douglas: A Case Report

• Lee KJ
• Kim YH
• Hwang YJ
• Kim SY
• Lee BH
• Lee JY
• Kim YS

• KMID: 1439471
• DOI: http://doi.org/10.3348/jksr.2012.66.6.539

Abstract

We report a case of surgically confirmed internal hernia through a peritoneal defect of the pouch of Douglas in a 25-year-old woman. This type of internal hernia is extremely rare, and to the best of our knowledge, only two cases have been reported in the English literature. Computed tomography (CT) showed a cluster of dilated small bowel loops on the posterior portion of the uterus and right side of the rectum, with a closely located proximal and distal transitional zone. We present the CT findings of this case and a literature review about the differential diagnosis of this condition.

MeSH Terms

Adult
Diagnosis, Differential
Female
Hernia
Humans
Rectum
Uterus

Reference

1. Takeyama N, Gokan T, Ohgiya Y, Satoh S, Hashizume T, Hataya K, et al. CT of internal hernias. Radiographics. 2005. 25:997–1015.

2. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006. 186:703–717.

3. Fiirgaard B, Agertoft A. Internal Richter's hernia due to congenital peritoneal defect. Case report. Acta Chir Scand. 1988. 154:537.

4. Inoue Y, Shibata T, Ishida T. CT of internal hernia through a peritoneal defect of the pouch of Douglas. AJR Am J Roentgenol. 2002. 179:1305–1306.

5. Blachar A, Federle MP, Dodson SF. Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology. 2001. 218:68–74.

6. Hong SS, Kim AY, Kim PN, Lee MG, Ha HK. Current diagnostic role of CT in evaluating internal hernia. J Comput Assist Tomogr. 2005. 29:604–609.

7. Mathieu D, Luciani A. GERMAD Group. Internal abdominal herniations. AJR Am J Roentgenol. 2004. 183:397–404.

8. Haku T, Daidouji K, Kawamura H, Matsuzaki M. Internal herniation through a defect of the broad ligament of the uterus. Abdom Imaging. 2004. 29:161–163.

9. Yamashiro T, Samura H, Kinjo M, Iida G, Gibo M, Murayama S, et al. CT of internal hernia through a defect of the perirectal fossa. Abdom Imaging. 2007. 32:320–322.

10. Chapman VM, Rhea JT, Novelline RA. Internal hernia through a defect in the broad ligament: a rare cause of intestinal obstruction. Emerg Radiol. 2003. 10:94–95.