Pericecal Hernias

Four peritoneal fossae in the ileocecal region as well as congenital and acquired defects in the mesentery of the cecum or appendix may lead to development of a pericecal hernia.7,9,19,73 The variety of other terms (ileocolic, retrocecal, ileocecal, paracecal) used to classify these hernias appear to have limited practical value in the radio-logic differential diagnosis and surgical management.16 In the collective review of 467 internal hernias by Hansmann and Morton,21 13% involved the ileocecal region. The clinical manifestations are usually intermittent episodes of right lower abdominal pain, tenderness small bowel distention, nausea, and vomiting. Chronic incarceration may produce symptoms compatible with

Pericecal Abscess

Fig. 16—35. Pericecal hernia.

The distal ileum protruding through a defect in the mesentery of the cecum is seen in the right lower abdomen, and there is gaseous distention of the proximal small intestine. The narrowed afferent segment of the herniated ileal loop (arrow) is identified. (Reproduced from Ghahremani and Meyers.16)

a periappendiceal abscess, Crohn's disease, or intestinal obstruction owing to adhesions.9,19

In most cases, a portion of ileum passes through defects in the mesentery of the cecum to occupy the right paracolic gutter. The correct diagnosis may be suggested on plain radiographs of the abdomen (Fig. 16-35). More useful are the delayed films of the small bowel series or a barium enema examination in which reflux into the terminal ileum has been achieved. Careful fluoroscopic evaluation and radiographs in lateral and oblique projections are particularly valuable for the demonstration of the fixed position of herniated loops posterolateral to the cecum.16 This is also true for the diagnosis ofinternal hernias that rarely develop through defects in a persistent ascending mesocolon18 (Fig. 16-36). In this condition, the radiologic differentiation from a transitory transmigration of the small intestine anteriorly over the ascending colon into the right paracolic gutter has clinical and prognostic significance.

Peritoneal Fossae

Fig. 16—35. Pericecal hernia.

The distal ileum protruding through a defect in the mesentery of the cecum is seen in the right lower abdomen, and there is gaseous distention of the proximal small intestine. The narrowed afferent segment of the herniated ileal loop (arrow) is identified. (Reproduced from Ghahremani and Meyers.16)

Fig. 16—36. Herniation of the ileal loops through a defect in a persistent ascending mesocolon.

There is moderate dilatation of the proximal small bowel, and there are gas-containing loops in the right paracolic gutter (arrows) displacing the ascending colon medially. (Reproduced from Ghahremani and Meyers.16)

Pericecal Hernia

Fig. 16—37. Intersigmoid hernia.

Barium enema examination, with retrograde filling of the small bowel, shows encapsulation of several ileal loops (arrows) within the intersigmoid fossa.

(Reproduced from Ghahremani and Meyers.32)

Essentials of Human Physiology

Essentials of Human Physiology

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  • Monika
    What causes a pericecal hernis?
    4 years ago

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