Pbp

Postoperative hernias can easily be missed in the absence of provocative maneuvers and/or proper positioning of the patient [114]. Steep oblique and lateral films (Fig. 1.50) as well as a Valsalva maneuver may increase the diagnostic accuracy on routine contrast studies [115]. On conventional small-bowel studies as well as on enteroclysis, multiple small-bowel loops are encapsulated, crowded together, and fixed in

Figure 1.50. Incisional hernia. Supine (A) and cross-table lateral films (B) of the abdomen reveal dilated loops of small bowel consistent with a small-bowel obstruction. The lateral film (B) shows a herniated loop of small bowel entering an incisional defect in the anterior abdominal wall.

location [116] (Figs. 1.51 and 1.52). In addition, the proximal small bowel dilated while loops distally are collapsed (Fig. 1.53). Smooth symmetric tapering of the barium column may be noted at the neck of the internal hernia [117] (Fig. 1.54). CT and MR imaging have certainly improved our ability to diagnose both incisional and internal postoperative hernias [112,116].

Figure 1.52. Incisional hernia. Another small-bowel series, similar in appearance to that seen in Figure 1.47, this time in a right lower quadrant incisional hernia.

Figure 1.51. Incisional hernia. Film from a small-bowel series shows a large encapsulated group of small-bowel loops in the pelvis, an incisional hernia.

Figure 1.52. Incisional hernia. Another small-bowel series, similar in appearance to that seen in Figure 1.47, this time in a right lower quadrant incisional hernia.

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