EURORAD ESR

Case 15294

Traumatic inferior lumbar hernia as a cause of acute bowel encarceration and perforation

Author(s)
Willian Schmitt, Pedro João, Pedro Marques, Ana Germano

Hospital Prof.Dr. Fernando Fonseca; IC 19 2720-276 Amadora, Portugal; Email:schmitt.wr@gmail.com
 
Patient
male, 33 year(s)
 
 
  • Figure 1
    Admission CT scan (trauma associated injuries)
     

    Axial CT showing a non-displaced fracture of the 10th left rib (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Reformatted coronal and axial CT demonstrating a spleen AAST grade II injury at the lower pole (curved arrows b and c).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Reformatted coronal and axial CT demonstrating a spleen AAST grade II injury at the lower pole (curved arrows b and c).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Reformatted coronal and axial CT showing a left iliac crest avulsion fracture (arrows d and e).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Reformatted coronal and axial CT showing a left iliac crest avulsion fracture (arrows d and e).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;
     
     
  • Figure 2
    Admission CT scan (traumatic lumbar hernia)
     

    Axial CT demonstrating a posterolateral abdominal wall defect, with disruption of latissimus dorsi muscle posteriorly (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Axial CT showing herniation of retroperitoneal fat through a traumatic left inferior triangle lumbar hernia (arrow). There is also a large hematoma at the deep subcutaneous tissue (star).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Reformatted coronal CT demonstrating the same imaging findings.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;
     
     
  • Figure 3
    Follow-up CT obtained 36 hours post admission
     

    Reformatted sagittal CT showing moderately small bowel distension and air-fluid levels

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Axial CT demonstrating the entrapped descending colon segment (arrow) with adjacent extraluminal retroperitoneal gas (curved arrow) due to perforation. There is also inflammatory swelling of the left psoas muscle (star).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Axial CT depicts the presence of free air in the retroperitoneal space (curved arrow). There is also a hematoma at the deep subcutaneous tissue (star).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;

    Axial CT showing herniation of the inferior portion of entrapped colon segment, between the iliac crest and the avulsed bony fragment (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Hernia;
     
     
Axial CT showing a non-displaced fracture of the 10th left rib (arrow).
 
Reformatted coronal and axial CT demonstrating a spleen AAST grade II injury at the lower pole (curved arrows b and c).
 
Reformatted coronal and axial CT demonstrating a spleen AAST grade II injury at the lower pole (curved arrows b and c).
 
Reformatted coronal and axial CT showing a left iliac crest avulsion fracture (arrows d and e).
 
Reformatted coronal and axial CT showing a left iliac crest avulsion fracture (arrows d and e).
 
Axial CT demonstrating a posterolateral abdominal wall defect, with disruption of latissimus dorsi muscle posteriorly (arrow).
 
Axial CT showing herniation of retroperitoneal fat through a traumatic left inferior triangle lumbar hernia (arrow). There is also a large hematoma at the deep subcutaneous tissue (star).
 
Reformatted coronal CT demonstrating the same imaging findings.
 
Reformatted sagittal CT showing moderately small bowel distension and air-fluid levels
 
Axial CT demonstrating the entrapped descending colon segment (arrow) with adjacent extraluminal retroperitoneal gas (curved arrow) due to perforation. There is also inflammatory swelling of the left psoas muscle (star).
 
Axial CT depicts the presence of free air in the retroperitoneal space (curved arrow). There is also a hematoma at the deep subcutaneous tissue (star).
 
Axial CT showing herniation of the inferior portion of entrapped colon segment, between the iliac crest and the avulsed bony fragment (arrow).
 
 
 
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