Exocoelomic internal hernia: elucidation of Papez's concept.

Two internal herinias of the intestines were found in adult males. One was a large translucent avascular membranous sac contining the small intestine from the duodenojejunal flexure to a point 6 in. proximal to the ileocaecal junction. The other was a peritoneal sac enclosing the small intestine, appendix, caecum and 6 in. of the ascending colon. The mesenteric and colic vessels were normal. Both hernias conformed to PAPEZ's concept of the so-called paraduodenal hernia that the hernial sac is derived from the umbilical coelom. The authors suggest that most of the so-called paraduodenal hernias are derived from the embryonic umbilical peritoneal diverticulum rather than from the peritoneal recesses or mesentery of the colon.