Paracaecal Hernia

This 54 year-old female presented with vomiting and obstipation. This axial CT image shows (click image for arrows):
* An isolated retrocaecal loop of small bowel, with pinched afferent and efferent limbs (blue arrows)
* Caecum displaced anteriorly (red arrow)
* Dilated loops of proximal small bowel (green arrows)
* Collapsed loops of distal small bowel (yellow arrows)
The findings are in keeping with a paracaecal hernia containing a loop of small bowel and causing obstruction.
Internal herniation is an uncommon cause of bowel obstruction. The potential sites for internal herniation are:
*The foramen of Winslow
*A hole in the mesentery
*A hole in the transverse mesocolon
*A defect in the broad ligament
*Congenital or acquired diaphragmatic hernia
*The left paraduodenal fossa
*The right duodenojejunal fossa
*The superior ileocaecal fossa
*The inferior ileocaecal fossa
*The retrocaecal fossa
Reference:
Mann CV, Russell RCG. Bailey & Love’s Short Practice of Surgery 21st edition. Chapman & Hall Medical 1992
Credit: Dr Laughlin Dawes
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