Internal hernia with necrotic colon
55 yo F with abdominal distention and vomiting. Conventional CT shows distended and malpositioned cecum and ascending colon, with a mesenteric swirl. On spectral analysis, note lack of perfusion in the distended colon and terminal ileum.
Lactate came back at 11. Patient taken emergently to the OR. Internal hernia with cecum and right colon herniated behind a Billroth 2 gastrojejunostomy. Colon necrotic and foul smelling, partial colectomy performed.