Internal hernias in children: spectrum of clinical and imaging findings

• Published in: Pediatric radiology 2011-12, Vol.41 (12), p.1559-1568
• Main Authors: Tang, Vivian, Daneman, Alan, Navarro, Oscar M., Miller, Stephen F., Gerstle, J. Ted
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Female; Hernia - diagnostic imaging; Hernia - pathology; Humans; Imaging; Infant, Newborn; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Radiography, Abdominal - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-011-2158-4

Background Internal hernias are uncommon in children and their clinical and imaging findings have not been widely addressed . Objective To determine the spectrum of clinical and imaging findings of internal hernia (IH) in children and to highlight diagnostic features. Materials and methods Review of clinical, imaging and surgical findings in 12 children with surgically proven IH. Results IH found in seven girls and five boys. Five of the children were neonates and seven were between ages 8–17 years. All neonates presented acutely and had transmesenteric internal hernias (TMIH) (four congenital, one acquired). In the older children, five presented with chronic symptoms and two presented with acute symptoms; the former had paraduodenal hernias (all congenital) and the latter had a congenital pericecal and an acquired TMIH. Only 2/5 neonatal TMIH could be appreciated on GI contrast examination. All five paraduodenal hernias were easily diagnosed on UGI series. CT, in two older children, depicted a paraduodenal hernia and the acquired TMIH. In 7/10 (70%) congenital IH, there was associated malrotation (in all four right paraduodenal hernias). Conclusion There is a wide spectrum of clinical and imaging findings of IH in children. TMIH were difficult to appreciate on GI contrast examinations, but paraduodenal hernias were easy to appreciate. One must have a high index of suspicion for right paraduodenal hernia if UGI series shows duodenum and proximal small bowel to the right of the spine.