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Special Feature
Oct 2011

Image of the Month—Diagnosis

Arch Surg. 2011;146(10):1215. doi:10.1001/archsurg.2011.261-b

A laparotomy was performed and showed an internal hernia through the left hepatic triangular ligament with small-bowel strangulation (Figure 2). Because of ileum necrosis, intestinal resection with side-to-side anastomosis was performed. The patient's postoperative course was uneventful.

Internal hernia is a rare condition that occurs in no more than 2% of cases of small-bowel occlusion.1 The main causes of peritoneal or mesenteric defects are congenital in young patients and traumatic or postoperative in adults.2,3

An anatomic classification of spontaneous internal hernia was recently reported by Gomes and Rodrigues.4 The most frequent sites for internal hernia were paraduodenal (53%), paracecal (13%), transmesenteric (8%), and through the Winslow foramen (8%).4 The incidence of internal hernia through the left hepatic triangular ligament is particularly hard to estimate. To the best of our knowledge, only 1 previous case has been reported in the literature.5