Bowel Disease

Richter Hernia (Parietal Hernia)

• Basically hernia but only part of the bowel wall is herniated and not the whole like (like a pseudo-hernia almost because all layers of bowel are not involved)

• Most commonly seen in femoral ring

• Higher chance of gangrene and less chance of obstruction

Spigelian Hernia

• Hernia through defect of internal oblique and transverse abdominus muscle aponeurosis

• Location

  • Inferior and lateral to umbilicus

  • Will be at or below level of arcuate line = no posterior rectus sheath at this level, TA and IO fibers run parallel here

  • Deep to external oblique aponeurosis

Evaluation

• Supine - air may not be seen in colon due to positioning

• Prone - air should be visible in colon

Crohns

• Wall thickening and enhancement

  • 3-5 mm

  • 5-9 mm

  • 10+ mm

• Comb sign - thickened vasa recta extend from thick bowel wall looking like a comb

• Skip lesions - normal bowel interspersed with diseased bowel

• Fistulas and Abscesses form

Celiac Disease

• Dilated, thickwalled and fluid filled loops of small bowel

• Jejunization of the ileum (increased bowel wall folds in the ileum and decreased wall folds in the jejunum)

Small Bowel Obstruction

• Complete SBO

  • Dilated proximal small bowel and collapsed distal bowel and colon with transition point

  • Transition point = where bowel goes from dilated to collapsed

• Ileus

  • Dilated proximal and distal small bowel with no transition point

• Partial small bowel obstruction

  • Somewhere in between complete SBO and ileus

  • Bowel is not as distended and transition point is not as definitive

  • Fecalization of the small bowel

    • Delayed transit in small bowel results in increasd water resorption and appearance of fecal material in the small bowel lumen

    • Seen in states of delayed transition, including partial SBO

• Closed loop obstruction

  • Piece of bowel occluded at proximal and distal ends - think of a sausage link

  • Can twist resulting in volvulus

Sclerosing Mesenteritis

• Affects jejunal mesentery

• Clusters of mesenteric nodules

Intestinal (Angioneurotic) Angioedema

• Basically angioedema like you get in the face but in the bowel

• Bowel wall edema, ascites

• Associated with ACEi use