Internal Hernia as a Cause of Acute Abdomen in a Pediatric Patient (original) (raw)

Internal Hernia as a Cause for Intestinal Obstruction in a Newborn

The Journal of emergency medicine, 2015

Background: An internal hernia is a rare cause of intestinal obstruction, which can occur at any age. Children most often develop an internal hernia due to a congenital defect in the mesentery. While some patients are asymptomatic, others present to medical attention with vague abdominal symptoms, an acute abdomen, or in shock. Case Report: We report a case of a 5-day-old previously healthy baby who presented to our pediatric emergency department with bilious vomiting, grossly bloody stool, and abdominal distention. During an exploratory laparotomy, the patient was diagnosed with an internal hernia caused by a congenital mesenteric defect. Why Should an Emergency Physician Be Aware of This?: Although internal hernia is an infrequent cause of intestinal obstruction in a newborn and requires emergent operative repair, it may be mistaken for other more common causes, such as necrotizing entercolitis, which are often managed medically. This case report aims to highlight some of the difficulties in diagnosis and key features that may assist the clinician in identifying these patients.

Congenital mesenteric defect — A rare cause of internal herniation in adults

Hellenic Journal of Surgery, 2014

Background: Mesenteric defect, congenital or acquired, is a rare cause of internal hernia. Most documented cases of internal hernias caused by congenital mesenteric defects are described in the paediatric population; its incidence is very rare in adults. Case report: We present the case of a previously asymptomatic 65-year-old man with a defect involving the mesentery of the terminal ileum. Almost the entire ileum had herniated through it twice in a complex manner and had become strangulated. The residual mesenteric defect was closed after relieving the obstruction, resecting the gangrenous part of ileum, and performing an end-to-side ileotransverse anastomosis. Results: The recovery was uneventful and the patient was discharged on the eleventh postoperative day. Conclusion: Reports of strangulated congenital mesenteric hernia at this age are scarce. Severe unexplained abdominal pain in adults with a virgin abdomen can be due to mesenteric hernia. A high index of suspicion and early surgical intervention can prevent a potential catastrophe.

Trans-Mesenteric Hernia in Infants: Report of Two Cases

Journal of Neonatal Surgery

Internal hernias are rare causes of intestinal obstruction in children. Trans-mesenteric hernia remains the most common form. We report transmesenteric hernia in a neonate and infant presented with intestinal obstruction.

Small Bowel Obstruction Caused by Internal Herniation Through a Mesenteric Defect—a Case Report

Indian Journal of Surgery, 2018

Small bowel obstruction due to internal herniation is a rare entity specially when there is no history of previous surgery. Here, we have described a 14-year female without any previous surgical history admitted with features of small bowel obstruction. Without improvement of symptom by conservative management, an operation was performed. During surgery, it was observed that distal ileum was herniated through a mesenteric defect of small bowel itself. Because of this herniation, there was a segment of gangrenous ileum which was resected, and anastomosis was performed. Later, patient was discharged without any complication.

Large congenital mesenteric defect presenting in an adult

Saudi Journal of Gastroenterology, 2010

Congenital internal hernia is a rare cause of bowel obstruction in adults and often presents with complications. A high index of suspicion, occasionally aided by appropriate radiological imaging, should lead to early surgical intervention and thus reduce morbidity and mortality. We describe a case of a 27-yearold woman who presented with upper abdominal pain and nonspecifi c abdominal signs. Computed tomography showed features of bowel ischemia which prompted surgical intervention. On exploration, she was found to have a large mesenteric defect with herniating ileum and ascending colon. A segment of gangrenous small bowel was resected. The mesenteric defect was repaired and the bowel tacked down to prevent volvulus. The patient made an uneventful recovery.

Early intestinal perforation secondary to congenital mesenteric defects

Journal of Pediatric Surgery Case Reports, 2016

Gastrointestinal perforation (GIP) in preterm neonates may be idiopathic, due to necrotizing enterocolitis (NEC), or mechanical obstruction. The predominant cause of GIP in the neonatal period is NEC. Differential diagnosis with congenital malformations, including mesenteric defects leading to internal hernias, is mandatory if the onset is early. We describe two newborns with trans-mesenteric herniation resulting in GIP, and we discuss the presence of possible additional risk factors such as prematurity and predisposing vascular disruption in connective tissue disorders (Ehlers-Danlos syndrome), twinning, and use of assisted reproductive technologies. These cases prompted us to review our exploratory laparotomies performed for intestinal obstruction, complicated/or not with perforation, to identify the frequency of neonatal trans-mesenteric hernias in a referral hospital. The prevalence of GIP and of internal hernia was 25% and 3.3%, respectively. In conclusion, time-onset and particular conditions associated with GIP should lead to a high index of suspicion for internal hernias in order to achieve appropriate diagnosis and therapy.

Clinical spectrum of internal hernia: A surgical emergency

Surgery Today, 2008

Purpose. To defi ne the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center. Methods. We reviewed the medical records, imaging studies, and operative fi ndings of 20 patients who underwent surgery for an internal hernia at our medical center between 1995 and 2005. The clinical characteristics and related indicators of the patients with, and those without bowel ischemia were compared and analyzed statistically.

Congenital middle mesocolic hernia – An unusual cause of small bowel obstruction

Hellenic Journal of Surgery, 2017

Internal herniation is a rare cause of small bowel obstruction, with an incidence of 0.2-0.9%. Obstruction due to congenital internal hernias is even rarer. The commonest type of congenital internal hernia is the paraduodenal or the mesocolic hernia. The left and right mesocolic hernias constitute 75% and 25% of the mesocolic hernias respectively. Middle mesocolic hernias are an extremely rare and unusual variant of mesocolic hernia, and literature search revealed only three reported cases. In view of its rarity, a high level of clinical suspicion, supported by radiological evidence is required to diagnose it preoperatively. Prompt surgical management is mandatory to reduce complications and their associated morbidity and mortality.

Congenital mesenteric defects in an adult: A case report

South Sudan Medical Journal

A congenital mesenteric defect in an adult is very rare, but can cause an internal hernia with small bowel obstruction. Awareness of congenital mesenteric defects is important to the general surgeon when faced with an acute abdominal condition. We report a case of a congenital mesenteric defect in a 40-year-old man who presented to the emergency department with acute abdominal pain. An X-ray revealed multiple air fluid levels with dilatation of small and large bowels suggestive of bowel obstruction or bowel ischaemia, or bowel perforations. He underwent an emergency laparotomy through a midline incision. A large mesenteric defect was discovered with viable small and large bowel. A primary repair of the defect was carried out. The patient had an uneventful recovery. Early diagnosis and treatment are essential to avoid bowel ischaemia and decrease the mortality and morbidity.