A 37-year-old man presented with progressively worsening colicky epigastric pain that became generalized and persistent. He had a similar episode 1 week prior, which resolved spontaneously. His abdomen was mildly distended and tympanitic in the epigastrium. Plain film of the abdomen showed dilated small-bowel loops, especially in the left upper quadrant. Nasogastric drainage produced 1.5 L of feculant material. Exploratory laparotomy revealed multiple dilated small-bowel loops which were traced back to a transition point where the small bowel was seen herniating through a tight well-formed, fibrous ring (Figure).
The small bowel herniating through a defect in the transverse colonic mesentery.
A. Diaphragmatic hernia
B. Congenital intra-abdominal band
C. Paraduodenal hernia
D. Intra-abdominal adhesions
E. Littre hernia
Singh RR, Warren P, Smith P, Wilson W. Image of the Month—Quiz Case. Arch Surg. 2006;141(7):711-712. doi:10.1001/archsurg.141.7.711