An Unusual Case of Internal Hernia Caused by Adhesion between the Sigmoid Colon and Salpingectomy Site (original) (raw)
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Cirugía Española (english Edition), 2014
Introduction: Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO). Patients and methods: From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required. Results: The mean age of the 33 patients who underwent surgery was 61.1AE17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83AE44 min and 7.8AE11.2 days, respectively. Operative time (72AE30 vs 123AE63 min.), tolerance to oral intake (1.8AE0.9 vs 5.7AE3.3 days) and length of postoperative stay (4.7AE2.5 vs 19.4AE21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group. Conclusions: In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short stay in hospital and low morbidity); its use would be fully justified in these cases.
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...
Internal Hernia Resulting in Bowel Obstruction After Laparoscopic Colectomy
CRSLS: MIS Case Reports from SLS, 2014
A 65-year-old woman underwent laparoscopic-assisted sigmoidectomy for management of sigmoid colon cancer. Her postoperative recovery was initially uneventful; however, on postoperative day 12, the patient suddenly complained of abdominal pain. Further surgical intervention was finally performed on postoperative day 21 because conservative treatment had been unsuccessful in relieving the obstruction. Laparoscopic surgery revealed that a segment of the proximal jejunum had herniated through an orifice, forming an adhesion between the mesentery of the ileum and the incised retroperitoneum of the mesenteric opening. The obstruction was relieved by laparoscopic adhesiolysis. Only 7 cases have previously been reported where the mesenteric opening has caused an internal hernia resulting in bowel obstruction. This case may suggest the need for closure of the mesenteric opening to prevent this complication after laparoscopic colectomy; however, there is no consensus on whether a mesenteric opening should be closed. Further research is needed to identify the patients who would benefit from the closure of mesenteric defects during laparoscopic-assisted colectomy.
Hernia, 2010
A description of two cases of internal herniation caused by a defect in the closure of the peritoneal flap during a trans-abdominal pre-peritoneal procedure is presented here. They were both successfully treated laparoscopically. This rare condition should be considered when patients who have had recent trans-abdominal surgery for inguinal hernia repair present with colicky lower abdominal pain-its aetiology may well be due to technical error. It is already established that laparoscopy is useful as a diagnostic and therapeutic tool in emergency cases, but it is also true that it is useful in case of early post-operative period complications following any laparoscopic procedure, such as the laparoscopic inguinal hernia repair.
Interparietal Herniation: A Rare Cause of Intestinal Obstruction
Journal of Medical Cases, 2010
An interparietal hernia is a rare form of hernia seen in the inguinal region. Its pathogenesis is not well understood. It frequently causes intestinal obstruction. We presented a case of interparietal herniation, who presented with acute symptoms and signs of intestinal obstruction. The male patient was referred to our department with acute signs of intestinal obstruction for three days. His physical examination revealed acute abdomen and intestinal obstruction. The ultrasound and computed tomography depicted an intra-abdominal mass of unknown origin. At operation, a loop of ileum was found incarcerated in an interparietal hernia. Reduction, resection and anastomosing of the segment were facilitated. The preperitoneal type of defect was closed with sutures. Interparietal hernias are rare, and represent a problem in the differential diagnosis of conditions functional in the inguinal region. It is more frequent in the males, and mostly presents with intestinal obstruction. Preoperative diagnosis of obstructing interparietal hernia is difficult. Once considered, its diagnosis and treatment is straightforward.
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.
Strangulation and Necrosis of an Epiploic Appendage of the Sigmoid Colon in a Right Inguinal Hernia
2016
Copyright © 2013 Yuri N. Shiryajev et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. An epiploic appendage of the sigmoid colon is considered to be an unusual type of inguinal hernia content. The strangulation of a sigmoid colon appendage into a right inguinal hernia is exclusively rare. We present a case of an 81-year-old female patient with severe cardiovascular comorbidities who was urgently admitted after an episode of strangulation and subsequent spontaneous reduction of a right inguinal hernia. The condition of the patient was stable, and an urgent operation was not indicated for three days after admission. However, we had to operate because the hernia strangulation recurred. In the hernia sac, a free fatty body (a separated and saponified epiploic appendage of the colon) and a strangulated epiploic appendag...
Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?
Case Reports in Plastic Surgery and Hand Surgery
Intestinal perforation (IP) is a life-threatening gastroenterological condition requiring urgent surgical care, which may present itself as an uncommon complication following incisional hernia repair surgery, most often because of iatrogenic traumatism occurring during the procedure. However, we report a case where a spontaneous onset can be hypothesised. A 60-years-old patient underwent repair of an abdominal laparocele, through rectus abdominis muscle plasty, 5 years after development of an incisional hernia due to exploratory laparotomy for the treatment of acute appendicitis. Xipho-pubic scar was excised and umbilicus and supra-umbilical hernia sac dissected, a linear median incision was performed along the sub-umbilical linea alba, reaching preperitoneal plane to assess any intestinal loop adherence to the abdominal wall. After limited viscerolysis, abdominal wall defect was corrected by 'rectus abdominis muscle plasty' and umbilicus reconstruction by Santanelli technique. Postoperative course was uneventful until Day 29, with sudden onset of epigastric pain, fever and bulge. Sixty cubic centimeter pus was drained percutaneously and cavity was rinsed with a 50% H2O2 and H2O V-V solution until draining clear fluid. Symptoms recurred two days later, while during rinsing presented dyspnoea. X-Ray and CT scan diagnosed IP, and she underwent under emergency an exploratory laparotomy, leading to right hemicolectomy extended to last ileal loops and middle third of the transverse, right monolateral salpingo-ovariectomy and a temporary ileostomy by general surgeon. Twenty-three days later an ileostomy reversal surgery was performed and 8 days after she was discharged. At latest follow-up patient showed fair conditions, complaining abdominal pain and diarrhoea, attributable to the extensive intestinal resection. IP following incisional hernia repair, is reported as uncommon and early postoperative complication. In our case, the previous regular postoperative course with late onset lead us to hypothesise a possible idiopathic etiopathogenesis, because of a strangulation followed by gangrene and abscess formation, which might begin before the incisional hernia repair and unnoticed at the time surgery was performed.
Small-Bowel Obstruction Secondary to Adhesions After Open or Laparoscopic Colorectal Surgery
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2016
Background and Objectives: Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO. Method: This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems. Results: During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P ϭ .16; hazards ratio (HR) 1.4 95% CI 0.82-2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P ϭ .039; HR 2.82; 95% CI 0.78-8.51). Stoma formation was an independent risk factor for development of SBO (P ϭ .049; HR, 0.63; 95% CI 0.39-1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P ϭ .0003; HR, 2.85; 95% CI 1.44-5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P ϭ .0001). Conclusion: The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is highly associated with a need for further surgical intervention.
Journal of surgical case reports, 2018
Internal hernia of the small bowel is a rare finding especially in previously non-operated abdomen. Such a hernia occurring due to involvement of appendices epiploicae is an even rare instance with less than five reported cases in the literature. We encountered a 75-year-old male who had internal herniation of small bowel through an aperture created by adhesion between two appendices epiploicae in a previously virgin abdomen. Laparotomy and division of adhesion was performed to manage him successfully. Even in a virgin abdomen, a high index of suspicion along with early intervention is the key to reduction in mortality and morbidity in cases intestinal obstruction.