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Unexpected internal hernia in a patient with small bowel obstruction: an old surgical axiom
  1. Adam Bryce,
  2. Chloe McMurray and
  3. Amir Hussain
  1. Department of General Surgery, Ayr Hospital, Ayr, UK
  1. Correspondence to Mr Adam Bryce; adambryce8{at}


An 85-year-old man with no previous laparotomies and no herniae presented with a small bowel obstruction. CT imaging did not suggest any obvious cause; however, a transition point at the terminal ileum was noted. At laparotomy, the small bowel was unexpectedly found to be obstructed through a tight anterior hiatal defect. No resection was required and the defect was closed. On retrospective review of the CT images, the herniated small bowel can clearly be seen anterior to the oesophagus and can also be appreciated as a retrocardiac air–fluid level on chest X-ray (initially felt to be a small type I hiatal hernia). Our case highlights the surgical axiom that in patients with small bowel obstruction with no scars and no herniae consideration should be given to an unusual or sinister cause.

  • general surgery
  • oesophagus

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  • Contributors AB produced the first draft of the manuscript and subsequent revisions CM obtained patient consent and follow-up information AH was the consultant responsible for the patient and overseeing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.