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Arch Surg. 2009;144(10):976.

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Answer: Incarcerated Paracecal Hernia

As we approached the end of the small bowel, we encountered a loop of terminal ileum incarcerated in a defect in the cecal mesentery. Gentle traction was applied with atraumatic forceps, which successfully released the incarcerated bowel. The mesentery around the defect was opened widely, thereby obliterating the natural orifice. The terminal ileum was then closely inspected and found to be viable. The patient tolerated the procedure. His postoperative course was uncomplicated, aside from a postoperative ileus that delayed the advancement of his diet. He was discharged on postoperative day 6 feeling well and tolerating a regular diet.

An internal hernia is defined as protrusion of a viscus through a peritoneal or mesenteric aperture. They are a rare cause of intestinal obstruction that make up fewer than 6% of all cases.^1-2 The aperture involved may be congenital, acquired secondary to surgery or trauma, or a preexisting anatomic structure such as . . . [Full Text of this Article]

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Arch Surg. 2009;144(10):975.
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