case_images: PMC6324651_01
case_images: Coronal view: arrow pointing to the dumb-bell transition point, where the proximal end of the closed loop small bowel herniated through a hole in the sigmoid epiploica.
case_images: rjy342f01.jpg
case_images: PMC6324651_01_rjy342f01.jpg
case_images: rjy342F1
case_images: A few distended loops bulged into a paraumbilical hernia, which was 6 cm wide and not the cause of obstruction (Figs 1-3).
case_images: Coronal view: arrow pointing to the sharp transition point, where the distal end of the closed loop small bowel herniated through a hole in the sigmoid epiploica, demonstrating collapsed small bowel distally.
case_images: rjy342f02.jpg
case_images: PMC6324651_01_rjy342f02.jpg
case_images: rjy342F2
case_images: A few distended loops bulged into a paraumbilical hernia, which was 6 cm wide and not the cause of obstruction (Figs 1-3).
case_images: Axial view: (A) and (B) arrows pointing to dilated small bowel from the closed loop obstruction. (C) and (D) arrows pointing to the transition point, where the small bowel is collapsed distally.
case_images: rjy342f03.jpg
case_images: PMC6324651_01_rjy342f03.jpg
case_images: rjy342F3
case_images: A few distended loops bulged into a paraumbilical hernia, which was 6 cm wide and not the cause of obstruction (Figs 1-3).
case_images: Intra-operative photo with index finger placed in the hole of the sigmoid epiploica, the site where small bowel is herniating through.
case_images: rjy342f04.jpg
case_images: PMC6324651_01_rjy342f04.jpg
case_images: rjy342F4
case_images: Through a midline incision, we eviscerated the dilated small bowel, and found a 40 cm long segment of small bowel herniating through a 2 cm defect of a sigmoid colonic epiploica (Figs 4 and 5).
case_images: Intra-operative photo, second view, with index finger placed in the hole of the sigmoid epiploica, demonstrating the closed loop of small bowel.
case_images: rjy342f05.jpg
case_images: PMC6324651_01_rjy342f05.jpg
case_images: rjy342F5
case_images: Through a midline incision, we eviscerated the dilated small bowel, and found a 40 cm long segment of small bowel herniating through a 2 cm defect of a sigmoid colonic epiploica (Figs 4 and 5).
case_images: Intra-operative photo, status-post reduction of internal hernia. The defect in the sigmoid epiploica is approximately 2 cm in diameter.
case_images: rjy342f06.jpg
case_images: PMC6324651_01_rjy342f06.jpg
case_images: rjy342F6
case_images: We used two Kelly clamps and 2-0 silk sutures to ligate and divide the sigmoid colon epiploica defect (Fig. 6).