Introduction: Internal hernia (IH) is a rare but significant cause of small bowel obstruction (SBO), often associated with high risk of strangulation and bowel ischemia. Due to nonspecific clinical manifestations, early and accurate diagnosis remains challenging. Multidetector computed tomography (CT) has emerged as the preferred imaging modality, offering detailed visualization of bowel loops and mesenteric vasculature. Methods: This retrospective study included 29 patients diagnosed with internal hernia-related SBO at two tertiary hospitals in Ho Chi Minh City between January 2018 and March 2023. All patients underwent contrast-enhanced abdominal CT prior to surgery. Imaging features were independently assessed by two radiologists and compared with intraoperative findings to evaluate diagnostic performance and subtype classification. Results: The most frequently encountered hernia subtype was transmesenteric (45%), followed by pericecal and sigmoid-related hernias (17% each). CT successfully identified internal hernias in 65.5% of cases and correctly classified the subtype in 37.9%. Key imaging features included clustered small bowel loops (65.5%), mesenteric vessel abnormalities (65.5%), and displacement of adjacent organs (65.5%). CT signs suggestive of ischemia, such as bowel wall thickening, fat stranding, and abnormal enhancement, were significantly associated with surgical confirmation of ischemia (P < 0.05). Conclusion: CT imaging plays a critical role in the diagnosis and management of internal hernias causing small bowel obstruction. While accurate subtype identification remains difficult, awareness of characteristic CT features can facilitate earlier diagnosis and intervention, potentially reducing morbidity from delayed treatment.  Kulcsszavak: internal hernia, small bowel obstruction, computed tomography, intestinal ischemia, transmesenteric hernia