Right-side fixation of the sigmoid colon causing internal herniation with closed-loop obstruction of both small and large bowel: a case report and review of the literature (original) (raw)
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Small bowel obstruction due to internal hernia through sigmoid epiploica
Journal of surgical case reports, 2019
Internal hernia is a rare cause of small bowel obstruction; even more rare is one that occurs through a sigmoid epiploica defect. There have been only two previously reported cases from this etiology, but both were without the advantage of highresolution imaging. We report the first color representation of this pathology, along with the first video recording of the internal hernia reduction. While this is a rare case, it is an important diagnosis to consider in the differential for patients presenting with a small bowel obstruction, with no previous abdominal surgeries or clinical findings of extra-abdominal hernias.
A 83 years old man was operated due to the acute abdominal findings and left strangulated inguinal hernia. On the exploration, trapping of sigmoid colon in the left inguinal canal observed and colonic wall was partly necrotic. After reduction, when the peritoneum covering the mesentery of the colon was opened, posterior wall defect and colonic content was seen in the mesentery. This view explained the CT that shows free air without free fluid in the abdomen.
Sub-hepatic Caecum with Extra-pelvic Looped Sigmoid Colon: An Embryological and Clinical Perspective
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: We encountered variation in the placement of large intestine in abdominal cavity of a 76-years-old male cadaver during dissection of abdominal cavity. The work was performed in Department of Anatomy during routine MBBS teaching sessions. The aim of this paper is to report coexistence of error of mid-gut development and along with variant topo-morphology of sigmoid colon in the same cadaver. Case Report: Sub-hepatic caecum with high riding vermiform appendix with absent ascending colon was seen on the right side of abdominal cavity. Concomitantly on the left side of the abdominal cavity dilated, looped sigmoid colon occupied the left hypochondrium, left lumbar region and left iliac fossa. We report these findings along with the embryological basis and clinical significance. Conclusion: An insight about the errors in development of mid-gut resulting into the variant topography of caecum will facilitate surgeons and radiologists in prompt diagnosis and quick modification of the protocol during invasive procedures.
Right Sided Sigmoid Colon and Redundant Descending Colon on Conventional and CT Imaging
The patient was referred for barium studies of colon, which showed a loop of colon in pelvic region (at normal location of ileal loops) and redundant and long descending colon extending across midline to reach hepatic flexure on right and continuing as sigmoid colon on right side. Transverse colon and ascending colon were normal in length and position. On CECT abdomen of the patient, a long segment of descending colon was identified. Its first part stretched obliquely from the splenic flexure to the right side traversing the umbilical quadrant, then it turned right of midline at the level of L5 vertebra. Later it turned upward and toward the right, ascending up to the level of body of L2 vertebra. The third part descended obliquely on the medial side of the ascending colon up to the pelvic brim. The fourth part was in the lesser pelvis and continued as the sigmoid colon in the right iliac fossa. The inferior mesenteric artery was seen arising from right side of ventral surface of abdominal aorta opposite third lumbar vertebra. Descending colon is part of large intestine which lies along the left side of abdomen, posterior to left kidney. It ends in sigmoid colon, which is situated in pelvis and ends in rectum at S3 level. While descending colon is a retroperitoneal structure, sigmoid colon is suspended by mesocolon. Various case reports are reported in literature regarding displaced descending colon discovered during anatomic dissection. Very few case reports have been made regarding identification of redundant colon in a clinical patient. We present a case of redundant and right sided descending colon with right sided sigmoid colon and double hepatic flexure, which has long redundant segments on barium enema and CECT abdomen. There is also associated variations in blood vessels supplying these anomalous colons. Case was confirmed on CECT abdomen.
A 83 years old man was operated due to the acute abdominal findings and left strangulated inguinal hernia. On the exploration, trapping of sigmoid colon in the left inguinal canal observed and colonic wall was partly necrotic. After reduction, when the peritoneum covering the mesentery of the colon was opened, posterior wall defect and colonic content was seen in the mesentery. This view explained the CT that shows free air without free fluid in the abdomen.
Internal hernia, in which the bowel herniates through a congenital or acquired aperture in the peritoneal cavity, is one of the rarest causes of ileus. Postoperative adhesion is a common pathological phenomenon that may cause bowel obstruction by angulation or twisting. However, internal herniation through a colonic adhesion formed after gynecologic surgery is extremely rare. Here, we present a case of strangulated small bowel obstruction in a 51-year-old woman, due to internal hernia through the aperture created by adhesion of the sigmoid colon and a right salpingectomy site. The patient presented with abdominal pain and distension; she had a history of right salpingectomy for ectopic pregnancy 20 years earlier. While attempting conservative management, peritoneal irritation signs developed and emergency surgery was performed. During the operation, it was found that approximately 30 cm of the ileum had herniated through the aperture created by the adhesion. After reduction of the incarcerated small bowel, bowel resection with primary anastomosis and adhesiolysis was performed. Although preoperative diagnosis is difficult in unusual types of internal hernias, due to their rarity, a high degree of suspicion and prompt management is crucial for the prevention of morbidity and mortality.