Internal abdominal hernias are rare causes of small bowel obstruction but carry a high risk of strangulation and bowel ischemia if not promptly recognized. We report the case of a 92-year-old man with a virgin abdomen who presented with acute abdominal pain and was found on computed tomography to have a closed-loop obstruction with a mesenteric “whirl sign.” Emergency laparotomy revealed the presence of a necrotic colonic loop strangulated by an internal adhesion with no history of prior abdominal surgery or trauma. Segmental colectomy with creation of a protective double-barrel ileostomy was performed, followed by uneventful recovery and subsequent reversal of the ileostomy. This case highlights the importance of considering internal hernia in elderly patients with bowel obstruction and no previous surgery, the value of CT and the “whirl sign” in raising early suspicion of a closed-loop process, and the need for timely surgical intervention to prevent any irreversible ischemic injury.
Farhat et al. (Thu,) studied this question.