Emergency MDCT in Internal Hernias: Short Reports Highlighting the Importance of Timely Surgical Intervention

To the Editor, Internal hernias (IHs) are rare clinical entities, with an overall incidence of <1%, defined as the protrusion of abdominal viscera through congenital or acquired defects in the peritoneum or mesentery [1,2].They account for approximately 5.8% of all mechanical small-bowel obstructions (SBOs) [2,3].Because the clinical presentation is nonspecific, diagnosis is often delayed; if left untreated, particularly when strangulation occurs, mortality exceeds 50% [2,3,4].Consequently, multidetector computed tomography (MDCT) with multiplanar reconstructions (MPRs) is the primary diagnostic tool [2,3].This short report includes three patients evaluated at Careggi University Hospital, a tertiary medical centre in Florence (2025-2026).Three cases with clinically and radiologically relevant features were selected from patients evaluated at our tertiary medical centre during 2025-2026.Initial CT scans were interpreted prospectively in the emergency setting by on-duty radiologists and subsequently reevaluated retrospectively after surgical confirmation. Short Report 1A 91-year-old woman presented to the emergency department (ED) with a 12-hour history of diffuse abdominal pain, progressive asthenia over the preceding weeks, and acute melaena.Her history included a hysterectomy 47 years earlier and uninvestigated chronic anaemia due to patient refusal.Physical examination (PE) revealed diffuse abdominal tenderness without peritoneal irritation.Laboratory tests showed severe anaemia (haemoglobin: 6.3 g/dL) and moderate leucocytosis (12,600/µL), with a normal Creactive protein level.Bedside ultrasound (US) demonstrated dilated small-bowel loops and free intraperitoneal fluid.