Concomitant Cholelithiasis, Isolated Colonic Hiatal Hernia, and Umbilical Hernia: Evaluation with CT

Kwok-Wan Yeung ； Tit-Cheng Ho ； Jyh-Ching Chen

《Journal of Radiological Science》 41卷2期 (2016/06) Pp. 57-60

https://doi.org/10.6698/JRS.201606_4102.04

摘要

A 58-year-old woman suffered from dyspnea, epigastric pain, and abdominal fullness for 1 day. She was overweight, with a body mass index (BMI) of 27.8 kg/m^2. Laparoscopic cholecystectomy had been performed 2 months prior for cholelithiasis and acute cholecystitis. The blood analysis revealed elevated liver enzymes (glutamic oxaloacetic transaminase, 199 μ/L; glutamic pyruvic transaminase, 125 μ/L). Contrast-enhanced multidetector row computed tomography (MDCT) of the abdomen showed a short segment of the small bowel loop incarcerated inside the umbilicus causing a closed-loop obstruction and dilatation of the proximal small bowel loop, a segment of the transverse colon herniated through the esophageal hiatus into the posterior mediastinum, with the gastroesophageal junction and stomach in the normal intra-abdominal location. Therefore, CT diagnosis of incarcerated umbilical hernia and isolated colonic hiatal hernia was established. Emergent laparotomy was performed with segmental resection of the incarcerated small bowel loop, end-to-side anastomosis, and hernioplasty of the umbilical hernia. The hiatal hernia was not closed because it was not incarcerated. The patient was discharged 10 days after the operation with an uneventful course.

關鍵字

cholelithiasis ； isolated colonic hiatal hernia ； umbilical hernia ； Saint's triad