Small bowel obstruction due to internal hernia through sigmoid epiploica (original) (raw)
Related papers
A Rare Type of Primary Internal Hernia Causing Small Intestinal Obstruction
Case Reports in Surgery, 2016
Primary internal hernias are extremely rare in adults. They are an important cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is nonspecific. Imaging has been of limited utility in cases of acute intestinal obstruction; moreover, interpretation of imaging features is operator dependant. Thus, internal hernias are usually detected at laparotomy and preoperative diagnosis in an emergency setting is either difficult or most of the time not suspected. We report herein a case of a 45-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the sigmoid colon in the left paracolic gutter. The segment of intestine was reduced and the hernial defect was closed. Our finding represents an extremely rare v...
American Journal of Case Reports, 2021
Internal hernias involve protrusion of the small bowel through a peritoneal or mesenteric space in the abdominal or pelvic cavity. Congenital internal small bowel hernias are rare and patients with them usually present with small bowel obstruction (SBO) at a young age, whereas in older patients, internal small bowel hernias usually are acquired secondary to previous surgery. The present report is of a rare case of SBO due to dual congenital internal small bowel hernias in a 51-year-old man with no history of abdominal surgery. Case Report: We report a case of dual congenital internal hernias of the small bowel in a patient who presented with symptoms and signs of SBO. He had no history of abdominal trauma, surgery, or comorbid conditions. His abdomen was mildly distended with minimal tenderness in the upper left quadrant but there was no guarding or rebound tenderness. Abdominal X-rays confirmed the SBO. A contrast-enhanced computed tomography scan of the patient's abdomen revealed SBO with transition at 2 points, suggestive of a closed-loop obstruction. However, the exact cause of the SBO was confirmed at laparotomy, which revealed dual internal hernias (intramesosigmoid and paraduodenal). The hernias were managed individually and the patient had a successful outcome after surgery. Conclusions: Although the present report is of a rare presentation of internal small bowel hernia, the case underscores that patients with this condition may present with SBO. Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of the hernia sac.
An Incarcerated Inguinal Sigmoid Hernia Case Report with Large Bowel Obstruction
BioRes Scientia , 2024
Abstract Background: Inguinal hernia is a term used to describe a protrusion of the peritoneum in the inguinal region, either with or without other contents. It's rare to find a sigmoid inguinal hernia. Case Report: A 75-year-old patient presented with symptoms and signs consistent with large bowel obstruction. For four years, he also had a reducible swelling in his right inguinal and epigastric regions, but after four days, it stopped being reducible. Due to a prior trans vesical prostatectomy, a large bowel post-operative adhesion was taken into consideration. The patient's x-ray revealed complete large bowel obstruction. An incarcerated sigmoid colon right inguinal hernia and omental epigastric hernia were found after entering the abdomen through a vertical mid-abdominal incision. The viable sigmoid colon and momentum from each hernia were then reduced, respectively. After completing a modified Bassini procedure using separate inguinal incisions for an inguinal hernia and direct repair for an epigastric hernia, the patient was discharged after 48 hours. The epigastric hernia repair was done because it was on the vertical abdominal incision site. Conclusion: Large bowel inguinal hernias are not common, but it's crucial to consider large bowel obstruction when there are suggestive x-ray features, like our patient. Keywords: incarceration; hernia; obstruction
Epigastric hernia complicated with bowel ischaemia
Sri Lanka Journal of Surgery, 2022
Epigastric hernia, a form of abdominal ventral hernia, accounts for 0.5-10.0% of all abdominal wall hernias. These may be congenital due to incomplete midline fusion of developing lateral abdominal wall domains or acquired. It usually occurs in individuals in the age groups of 20 to 50 years and infants. It is rarely large enough to admit more than a small amount of extra-peritoneal fat. We discuss an epigastric hernia known only for a little more than 4-hours, presented strangulated, leading to ischaemia of small bowel requiring resection and review literature on epigastric hernias and their complications.
Surgical Case Reports
It is well known that intersigmoid hernia (ISH) is a rare condition. Here we describe our experience of laparoscopic surgery for small-bowel obstruction (SBO) due to ISH after sufficient decompression involving long-tube insertion. A 45-year-old woman with no history of abdominal surgery visited our hospital with epigastric pain. She was diagnosed as having SBO and underwent long-tube insertion as conservative therapy. However, her symptoms did not improve. Gastrografin contrast enema via the long-tube demonstrated a beak sign in the lower left abdomen and CT showed incarcerated small bowel was successively covered by sigmoid mesocolon, suggesting that the SBO was due to ISH, and she underwent laparoscopic surgery after sufficient decompression of the dilated small bowel. Intraoperative examination demonstrated incarceration of a loop of the small bowel in the intersigmoid fossa without strangulation. Because the incarcerated portion of the small bowel was not necrotized, herniation repair was performed by removing the incarcerated small bowel from the intersigmoid fossa without closure of the hernia orifice. The postoperative course was uneventful, and the patient is now free of symptoms and recurrence 12 months after surgery. Laparoscopic surgery after sufficient decompression is a useful treatment for SBO due to ISH.
CASE REPORT AND REVIEW OF LITERATURE Epigastric hernia complicated with bowel ischaemia
2022
Epigastric hernia, a form of abdominal ventral hernia, accounts for 0.5 – 10.0% of all abdominal wall hernias. These may be congenital due to incomplete midline fusion of developing lateral abdominal wall domains or acquired. It usually occurs in individuals in the age groups of 20 to 50 years and infants. It is rarely large enough to admit more than a small amount of extra-peritoneal fat. We discuss an epigastric hernia known only for a little more than 4-hours, presented strangulated, leading to ischaemia of small bowel requiring resection and review literature on epigastric hernias and their complications.
Journal of Medical Case Reports
Background Right-side fixation of the sigmoid colon is a rare anatomical variant associated with intestinal malrotation (Choi et al. in J Korean Surg Soc. 84(4):256–60, 2013). Differently from other forms of malrotation, this variant has not been associated thus far with acute surgical conditions. Case presentation In this report, we present a 65-year-old Caucasian patient admitted for bowel obstruction symptoms. Computed tomography scan revealed right-side fixation of the sigmoid colon extended to the subhepatic recess complicated by obstructed internal herniation of the ileum. In this patient, the sigmoid colon occupied a recess posterior to the ascending colon and right Toldt’s fascia. Within this narrow anatomical space, an ileal loop was trapped causing internal herniation with resultant close-bowel obstruction of both ileum and sigmoid colon. The ileal loop was released surgically and the anatomical abnormality corrected. Conclusions To our knowledge, this is the first case of...
Small bowel obstruction secondary to paravesical hernia
BACKGROUND: Bowel obstruction in the setting of the unscarred abdomen can be due to a wide variety of causes. Internal hernias are a rare cause of bowel obstruction with paravesical hernia being exceedingly rare. Paravesical hernia should form part of the differential diagnosis in the patient presenting with bowel obstruction. Prompt management and reduction of the incarcerated bowel are essential. This will prevent further complications especially related to bowel ischemia. CASE SUMMARY: The patient presented with a classical history of small bowel obstruction. Abdominal Xray revealed distended loops of small bowel and absence of air in the rectum. An exploratory laparotomy revealed a paravesical internal hernia. A loop of terminal ileum had incarcerated and was the cause of the bowel obstruction. The defect was repaired after reducing the bowel and the patient made an uneventful recovery. CONCLUSION: Internal paravesical hernia although extremely rare should form part of the differential diagnosis in the patient presenting with small bowel obstruction especially in the previously unscarred abdomen. If the obstruction is complete then prompt exploration via laparotomy or laparoscopy is required. Delays in definitive management may result in marginally viable bowel becoming ischemic and requiring bowel resection.
Internal hernias: anatomical basis and clinical relevance
Surgical and Radiologic Anatomy, 2007
The aim of this study was to present and discuss the anatomical basis of internal hernias thanks to our clinical experience of 14 cases. Internal hernias are uncommon cases of acute intestinal obstruction when a viscera protrudes through an intraperitoneal oriWce, remaining inside the peritoneal cavity. It excludes iatrogenic post surgical hernias. From an anatomical point of view, three kinds of oriWces may be interested. The oriWce may be normal: epiploic or omental (Winslow's) foramen, or abnormal through a pathologic transomental hole realizing an internal prolapsus or procidentia, without sac. Or this oriWce may be a paranormal peritoneal fossa (para duodenal or retrocaecal) acting as a trap for the bowel: these hernias possess a sac and are considered as true hernias. The clinical diagnosis is always diYcult. CT scan can be useful conWrming the obstruction and leads to an urgent operation. This retrospective study evaluates diagnosis, management and follow-up according to the type of anatomical oriWce and delay of surgery.