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Special Feature
February 2003

Image of the Month—Diagnosis

Arch Surg. 2003;138(2):226. doi:10.1001/archsurg.138.2.225

Figure 1. A plain abdominal radiograph shows a distribution of gas throughout the colon.

Figure 2. A single-contrast barium enema x-ray film shows a loop of transverse colon herniating through a defect in the falciform ligament, with dilation of the proximal colon.

An internal hernia is defined as a protrusion of abdominal viscera through a normal or abnormal aperture within the confines of the peritoneal cavity. These hernias may be either congenital or acquired and account for less than 10% of all cases of intestinal obstruction. Internal hernias may involve defects in the mesentery of the small or large intestine, the mesoappendix, the broad ligament, the lesser omentum, and the foramen of Winslow. Alternatively, they may occur in one of the multiple fossae and recesses among the peritoneal folds, such as paraduodenal, paracecal, supravesical, retrovesical, retrorectal, or the foramen of Winslow.

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