RadioGraphics
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

DOI: 10.1148/rg.263055714
This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zafar, H. M.
Right arrow Articles by Laufer, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Zafar, H. M.
Right arrow Articles by Laufer, I.
Related Collections
Right arrow Gastrointestinal Radiology

Anterior Abdominal Wall Hernias: Findings in Barium Studies1

Hanna M. Zafar, MD, Marc S. Levine, MD, Stephen E. Rubesin, MD and Igor Laufer, MD

1 From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. Received July 7, 2005; revision requested September 7 and received September 21; accepted September 22. All authors have no financial relationships to disclose.

Figure 1
View larger version (99K):

[in a new window]
  		Figure 1a.  Small anterior abdominal wall hernia in a 42-year-old woman. (a) Right lateral spot image from a small-bowel follow-through examination shows a single small-bowel loop (arrow) anterior to the fascial planes of the anterior abdominal wall. Note the narrowing of the loop where it enters and exits the hernia (arrowheads). (b) Right lateral spot image shows reduction of the hernia with manual palpation. (Arrow indicates a lead glove.)

 

Figure 1
View larger version (105K):

[in a new window]
  		Figure 1b.  Small anterior abdominal wall hernia in a 42-year-old woman. (a) Right lateral spot image from a small-bowel follow-through examination shows a single small-bowel loop (arrow) anterior to the fascial planes of the anterior abdominal wall. Note the narrowing of the loop where it enters and exits the hernia (arrowheads). (b) Right lateral spot image shows reduction of the hernia with manual palpation. (Arrow indicates a lead glove.)

 

Figure 2
View larger version (123K):

[in a new window]
  		Figure 2a.  Large anterior abdominal wall hernia in a 56-year-old woman. (a) Right lateral spot image from a small-bowel follow-through examination shows multiple loops of small bowel (arrows) anterior to the fascial planes of the anterior abdominal wall. Note the minimal extrinsic compression of the bowel loops where they enter and exit the large hernial orifice (arrowheads). (b) Right lateral spot image shows reduction of the hernia with manual palpation. (Arrow indicates a lead glove.)

 

Figure 2
View larger version (121K):

[in a new window]
  		Figure 2b.  Large anterior abdominal wall hernia in a 56-year-old woman. (a) Right lateral spot image from a small-bowel follow-through examination shows multiple loops of small bowel (arrows) anterior to the fascial planes of the anterior abdominal wall. Note the minimal extrinsic compression of the bowel loops where they enter and exit the large hernial orifice (arrowheads). (b) Right lateral spot image shows reduction of the hernia with manual palpation. (Arrow indicates a lead glove.)

 

Figure 3
View larger version (137K):

[in a new window]
  		Figure 3.  Richter-type anterior abdominal wall hernia in a 55-year-old woman. Left posterior oblique spot image from a double-contrast barium enema study shows deformation of the anterior wall of the transverse colon (arrow) where it partially enters the hernial sac.

 

Figure 4
View larger version (128K):

[in a new window]
  		Figure 4a.  Richter-type anterior abdominal wall hernia in a 65-year-old woman. (a) Left posterior oblique spot image from a single-contrast barium enema study shows an outward bulge (arrow) in the inferior aspect of the distal transverse colon. (b) Contrast-enhanced CT scan shows an anterior bulge of the transverse colon in an area of diastasis recti, where the anterior wall of the transverse colon (arrow) enters a small hernial sac located to the left of the midline.

 

Figure 4
View larger version (148K):

[in a new window]
  		Figure 4b.  Richter-type anterior abdominal wall hernia in a 65-year-old woman. (a) Left posterior oblique spot image from a single-contrast barium enema study shows an outward bulge (arrow) in the inferior aspect of the distal transverse colon. (b) Contrast-enhanced CT scan shows an anterior bulge of the transverse colon in an area of diastasis recti, where the anterior wall of the transverse colon (arrow) enters a small hernial sac located to the left of the midline.

 

Figure 5
View larger version (122K):

[in a new window]
  		Figure 5.  Parastomal hernia in a 39-year-old woman who previously underwent ileostomy. Right lateral spot image from a small-bowel follow-through examination shows the location of the hernia (large arrow) alongside the distal ileum (small arrow), where the ileum transects the fascial planes of the anterior abdominal wall, at the stoma site. Note the presence of barium in the ileostomy bag.

 

Figure 6
View larger version (112K):

[in a new window]
  		Figure 6a.  Anterior abdominal wall hernia containing small bowel in a 43-year-old woman. (a) Frontal left posterior oblique spot image from a small-bowel follow-through examination shows lateral and inferior displacement of a small-bowel loop (arrowheads) in the left lower quadrant and extrinsic compression of the bowel (arrows). (b) Right lateral spot image shows a single small-bowel loop (arrowheads) anterior to the abdominal wall. Note the luminal narrowing (arrows) where the bowel enters and exits the hernial orifice. (c) Right lateral spot image during a Valsalva maneuver shows an increased number of small-bowel loops (arrows) in the hernial sac during the application of increased intra-abdominal pressure.

 

Figure 6
View larger version (108K):

[in a new window]
  		Figure 6b.  Anterior abdominal wall hernia containing small bowel in a 43-year-old woman. (a) Frontal left posterior oblique spot image from a small-bowel follow-through examination shows lateral and inferior displacement of a small-bowel loop (arrowheads) in the left lower quadrant and extrinsic compression of the bowel (arrows). (b) Right lateral spot image shows a single small-bowel loop (arrowheads) anterior to the abdominal wall. Note the luminal narrowing (arrows) where the bowel enters and exits the hernial orifice. (c) Right lateral spot image during a Valsalva maneuver shows an increased number of small-bowel loops (arrows) in the hernial sac during the application of increased intra-abdominal pressure.

 

Figure 6
View larger version (104K):

[in a new window]
  		Figure 6c.  Anterior abdominal wall hernia containing small bowel in a 43-year-old woman. (a) Frontal left posterior oblique spot image from a small-bowel follow-through examination shows lateral and inferior displacement of a small-bowel loop (arrowheads) in the left lower quadrant and extrinsic compression of the bowel (arrows). (b) Right lateral spot image shows a single small-bowel loop (arrowheads) anterior to the abdominal wall. Note the luminal narrowing (arrows) where the bowel enters and exits the hernial orifice. (c) Right lateral spot image during a Valsalva maneuver shows an increased number of small-bowel loops (arrows) in the hernial sac during the application of increased intra-abdominal pressure.

 

Figure 7
View larger version (133K):

[in a new window]
  		Figure 7a.  Anterior abdominal wall hernia containing transverse colon in a 74-year-old woman. (a) Frontal spot image from a single-contrast barium enema study shows a confusing appearance, with a mildly dilated colonic loop (arrows) inferior to the remaining transverse colon. (b) Right lateral spot image from the same study shows a loop of transverse colon (arrows) anterior to the abdominal wall. Note the luminal narrowing (arrowheads) where the bowel enters and exits the hernial orifice. The entering and exiting bowel limbs are superimposed in this view.

 

Figure 7
View larger version (97K):

[in a new window]
  		Figure 7b.  Anterior abdominal wall hernia containing transverse colon in a 74-year-old woman. (a) Frontal spot image from a single-contrast barium enema study shows a confusing appearance, with a mildly dilated colonic loop (arrows) inferior to the remaining transverse colon. (b) Right lateral spot image from the same study shows a loop of transverse colon (arrows) anterior to the abdominal wall. Note the luminal narrowing (arrowheads) where the bowel enters and exits the hernial orifice. The entering and exiting bowel limbs are superimposed in this view.

 

Figure 8
View larger version (102K):

[in a new window]
  		Figure 8a.  Anterior abdominal wall hernia containing gastric antrum in an 85-year-old woman. (a) Lateral spot image from a single-contrast upper gastrointestinal tract series and small-bowel follow-through examination shows the gastric antrum (arrows) in a hernial sac anterior to the fascial planes of the anterior abdominal wall. (b) Contrast-enhanced CT scan shows the portion of the gastric antrum (arrows) within the midline hernia.

 

Figure 8
View larger version (144K):

[in a new window]
  		Figure 8b.  Anterior abdominal wall hernia containing gastric antrum in an 85-year-old woman. (a) Lateral spot image from a single-contrast upper gastrointestinal tract series and small-bowel follow-through examination shows the gastric antrum (arrows) in a hernial sac anterior to the fascial planes of the anterior abdominal wall. (b) Contrast-enhanced CT scan shows the portion of the gastric antrum (arrows) within the midline hernia.

 

Figure 9
View larger version (95K):

[in a new window]
  		Figure 9.  Multiple anterior abdominal wall hernias containing small bowel in a 68-year-old woman. Right lateral spot image from a small-bowel follow-through examination shows four separate hernias that contain small bowel (arrows). All of the hernias arose along a midline abdominal incision.

 

Figure 10
View larger version (138K):

[in a new window]
  		Figure 10a.  Partial small-bowel obstruction due to an incarcerated anterior abdominal wall hernia in a 63-year-old man. (a) Frontal spot image from a small-bowel follow-through examination shows multiple loops of dilated small bowel (arrows) in the lower abdomen and collapsed loops of ileum (arrowheads) more distally. These findings are suggestive of partial small-bowel obstruction, but the site of the obstruction is uncertain. (b) Lateral spot image shows multiple loops of dilated small bowel, with one loop (large arrows) in the hernial sac. Note the focal narrowing of this loop where it enters and exits the hernial orifice (small arrows) and the collapsed small-bowel loop (arrowheads) distal to the hernia. The hernia could not be reduced with manual palpation. These findings indicate a partial small-bowel obstruction due to incarceration. (c) Unenhanced CT scan shows multiple loops of dilated small bowel (arrows), with one loop (arrowheads) entering the anterior abdominal wall hernia. (d) CT scan at an adjacent level shows a collapsed small-bowel loop (arrowheads) where it exits the hernia, as well as several dilated small-bowel loops (arrows) located more proximally.

 

Figure 10
View larger version (106K):

[in a new window]
  		Figure 10b.  Partial small-bowel obstruction due to an incarcerated anterior abdominal wall hernia in a 63-year-old man. (a) Frontal spot image from a small-bowel follow-through examination shows multiple loops of dilated small bowel (arrows) in the lower abdomen and collapsed loops of ileum (arrowheads) more distally. These findings are suggestive of partial small-bowel obstruction, but the site of the obstruction is uncertain. (b) Lateral spot image shows multiple loops of dilated small bowel, with one loop (large arrows) in the hernial sac. Note the focal narrowing of this loop where it enters and exits the hernial orifice (small arrows) and the collapsed small-bowel loop (arrowheads) distal to the hernia. The hernia could not be reduced with manual palpation. These findings indicate a partial small-bowel obstruction due to incarceration. (c) Unenhanced CT scan shows multiple loops of dilated small bowel (arrows), with one loop (arrowheads) entering the anterior abdominal wall hernia. (d) CT scan at an adjacent level shows a collapsed small-bowel loop (arrowheads) where it exits the hernia, as well as several dilated small-bowel loops (arrows) located more proximally.

 

Figure 10
View larger version (165K):

[in a new window]
  		Figure 10c.  Partial small-bowel obstruction due to an incarcerated anterior abdominal wall hernia in a 63-year-old man. (a) Frontal spot image from a small-bowel follow-through examination shows multiple loops of dilated small bowel (arrows) in the lower abdomen and collapsed loops of ileum (arrowheads) more distally. These findings are suggestive of partial small-bowel obstruction, but the site of the obstruction is uncertain. (b) Lateral spot image shows multiple loops of dilated small bowel, with one loop (large arrows) in the hernial sac. Note the focal narrowing of this loop where it enters and exits the hernial orifice (small arrows) and the collapsed small-bowel loop (arrowheads) distal to the hernia. The hernia could not be reduced with manual palpation. These findings indicate a partial small-bowel obstruction due to incarceration. (c) Unenhanced CT scan shows multiple loops of dilated small bowel (arrows), with one loop (arrowheads) entering the anterior abdominal wall hernia. (d) CT scan at an adjacent level shows a collapsed small-bowel loop (arrowheads) where it exits the hernia, as well as several dilated small-bowel loops (arrows) located more proximally.

 

Figure 10
View larger version (161K):

[in a new window]
  		Figure 10d.  Partial small-bowel obstruction due to an incarcerated anterior abdominal wall hernia in a 63-year-old man. (a) Frontal spot image from a small-bowel follow-through examination shows multiple loops of dilated small bowel (arrows) in the lower abdomen and collapsed loops of ileum (arrowheads) more distally. These findings are suggestive of partial small-bowel obstruction, but the site of the obstruction is uncertain. (b) Lateral spot image shows multiple loops of dilated small bowel, with one loop (large arrows) in the hernial sac. Note the focal narrowing of this loop where it enters and exits the hernial orifice (small arrows) and the collapsed small-bowel loop (arrowheads) distal to the hernia. The hernia could not be reduced with manual palpation. These findings indicate a partial small-bowel obstruction due to incarceration. (c) Unenhanced CT scan shows multiple loops of dilated small bowel (arrows), with one loop (arrowheads) entering the anterior abdominal wall hernia. (d) CT scan at an adjacent level shows a collapsed small-bowel loop (arrowheads) where it exits the hernia, as well as several dilated small-bowel loops (arrows) located more proximally.

 

Figure 11
View larger version (128K):

[in a new window]
  		Figure 11a.  Retrograde colonic obstruction caused by an incarcerated anterior abdominal wall hernia in an 84-year-old woman. (a) Right posterior oblique spot image from a single-contrast barium enema study shows an abrupt transition (arrow) in a middle segment of the transverse colon, with an absence of colonic filling more proximally. (b) Right lateral spot image shows narrowing of the transverse colon (black arrow) where it enters the hernial orifice, a dilated colonic loop (white arrows) in the hernial sac, and complete obstruction (arrowhead) where the colon exits the hernia. This hernia could not be reduced with manual palpation.

 

Figure 11
View larger version (109K):

[in a new window]
  		Figure 11b.  Retrograde colonic obstruction caused by an incarcerated anterior abdominal wall hernia in an 84-year-old woman. (a) Right posterior oblique spot image from a single-contrast barium enema study shows an abrupt transition (arrow) in a middle segment of the transverse colon, with an absence of colonic filling more proximally. (b) Right lateral spot image shows narrowing of the transverse colon (black arrow) where it enters the hernial orifice, a dilated colonic loop (white arrows) in the hernial sac, and complete obstruction (arrowhead) where the colon exits the hernia. This hernia could not be reduced with manual palpation.

 




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOGRAPHICS RADIOLOGY RSNA JOURNALS ONLINE
Copyright © 2006 by the Radiological Society of North America.