Combined Transmesocolic-Transomental Internal Hernia

Chou CK, Mark C-W, Wu R-H, Chang J-M nternal hernia of the small bowel into the lesser sac through a defect in the transverse mesocolon has been described [1–4]. The herniated small bowel may be seen above the gastric lower body and to the right of the gastric upper body on the anteroposterior projection and dorsal to the stomach and the transverse colon on the lateral projection of radiographs and barium studies. It may reenter into the greater peritoneal cavity via the foramen of Winslow or a defect in either the gastrohepatic or the gastrocolic ligament [5]. The imaging findings of these combined hernias are scant [4]. Because of the potential risks of small-bowel obstruction, strangulation, and gangrene, timely diagnosis is important. We report the CT findings, which have not been described to our knowledge, of a case of spontaneous herniation of the small bowel through a defect in the transverse mesocolon and the lesser omentum (the gastrohepatic ligament) into the right upper greater peritoneal cavity.