• closed loop bowel obstruction
• diagnostic laparoscopy
• internal hernia
• spontaneous hernia
• transomental hernia

• Analgesia
• Hernia repair
• Laparoscopy
• Pain neuroscience education
• Post-surgical pain
• Recovery

• Humans
• Male
• Hernia, Inguinal/surgery
• Female
• Middle Aged
• Laparoscopy/adverse effects
• Pain, Postoperative/etiology
• Adult
• Herniorrhaphy/adverse effects
• Herniorrhaphy/methods
• Aged
• Pain Measurement
• Pain Management/methods
• Neurosciences/education
• Patient Education as Topic
• Surveys and Questionnaires

• 2020jstg026 Technology Promotion Project of Chongqing Health Administration
• 2020MSXM042 Chongqing Kewei Joint Technology Innovation and Application Development Project

• abdominal hernia
• gastric bypass
• petersen's hernia
• pouch of douglas
• small bowel obstruction

• Iron deficiency anemia
• Jejunal diverticulosis
• Paraduodenal hernia

• intestinal obstruction
• landzert's fossa
• laparotomy
• left para-duodenal hernia
• surgical management

• gastrointestinal ileus
• laparoscopic treatment
• mesocolic hernia
• recurrent upper abdominal pain
• vomit

Intersigmoid hernia is a rare form of internal hernia presenting with symptoms of bowel obstruction. A 32-year-old male visited the emergency department with chief complaint of abrupt onset of abdominal pain without any history of prior abdominal surgery. The initial abdominal X-ray and computed tomography (CT) scan exhibited mild distension of small bowel and paralytic ileus with no definitive obstruction site. However, a 12-h follow-up abdominal X-ray showed manifestations of newly appeared step-ladder sign and the CT scan displayed mechanical obstruction in the left lower quadrant area. Upon laparoscopic examination, herniation of small bowel was observed through the intersigmoid recess. Reduction was performed for about 5 cm of incarcerated ileum, and there was no sign of necrosis or lasting damage. The patient was discharged without complications. Laparoscopic management of intersigmoid hernia is possible with early surgical management of mechanical obstruction.

• falciform ligament hernia
• murphy's sign
• pyoperitoneum
• strangulated hernia
• surgical acute abdomen

• Bowel obstruction
• Hernia
• Intestinal obstruction
• Small bowel
• Small bowel obstruction

The transmesosigmoid hernia is a rare type of sigmoid mesocolon hernia. Its presentation is non-specific and thus hardly ever preoperatively diagnosed. Its diagnosis often requires surgical corroboration. This case report aims to improve on the preoperative diagnosis with a proposed observed sign on CT. All literature reviewed described radiological findings related to the small bowel; thus, features of small bowel obstruction was the “hallmark” of internal hernias. This paper intends to describe the features of the sigmoid mesocolon internal hernias, illustrate and propose a never reported configuration of the sigmoid colon. This sigmoid colon configuration has a resemblance to the omega sign. We intend to present a new hallmark sign, which may serve as a clue in the identification of internal hernias involving the sigmoid mesocolon.

• Internal hernia
• Laparoscopic anterior resection
• Laparoscopic colorectal surgery
• Mesenteric defects

• gastrointestinal surgery
• general surgery

• gastrointestinal surgery
• general surgery

• Adult
• Humans
• Intestinal Obstruction/etiology
• Kidney Failure, Chronic/surgery
• Kidney Transplantation/adverse effects
• Male
• Reoperation/adverse effects
• Ureteral Obstruction/etiology

• gastrointestinal surgery
• general surgery

There are still discrepancies among general/colorectal surgeons regarding closure of mesenteric defect in scientific literature. This study aimed to assess the long-term consequences of nonclosure of the mesenteric defect after open right colectomy.

A 7-year retrospectively collected and continuous database revealed 212 consecutive patients who had undergone traditional right colectomy without closing the mesenteric defects at Kaohsiung Chung-Gung Memorial Hospital; all patients were operated by a single surgeon. Among these patients, 17 were excluded (those who died within 30 days after surgery or those who received an end ileostomy). The mean age of the 195 patients (58% men and 42% women) was 61.6 ± 12.6 years, and the follow-up period was 4.1 ± 2.8 years (interquartile range 0.09 ~ 10.4).

Forty-four patients (22.5%) encountered intestinal obstruction. Nine (20.4%) required surgical intervention. The cause of intestinal obstruction was adhesion (n=1), ventral hernia (n=1), and cancer recurrence (n=7). Conservative treatment was successful in 35 patients. The intestinal obstruction group (n = 44) were similar to the no-intestinal obstruction group (n = 151) in terms of the following parameters: age, sex, previous abdominal surgery, indication for colectomy, and procedure related complications. Carcinomatosis was found to increase the incidence of intestinal obstruction. No patient developed intestinal obstruction because of the nonclosure of mesenteric defects after right colectomy.

This study suggested that routine procedure of closing the mesenteric defect after open right colectomy might not be beneficial. Additional studies with extended long-term follow-up periods are needed to confirm the benefits of the nonclosure.

• Congenital mesenteric defect
• Herniation
• Mesenteric lymphadenopathy
• Small intestinal obstruction
• Sudden death

Robotic assisted pancreaticoduodenectomy (RPD) is reported to be safe and feasible. Internal hernia (IH) after RPD is a serious but rarely reported complication.

We retrospectively reviewed data of 231 patients who underwent RPD from October 2010 to December 2016. The incidence, symptoms, time of presentation, and outcome were investigated.

Five patients (2.6%) were diagnosed with IH. Significant correlation (P<0.001) between IH and transverse mesocolon defect was confirmed. In patients without defect closure, the incidence of IH was 62.5%, while patients who received defect closure experienced no IH. The median time between initial surgery and occurrence of IH was 76 days. The main symptoms were abdominal pain, nausea, and vomiting. All patients received abdominal computed tomography (CT) and were suspected to have IH according to imaging and symptoms. All patients underwent reoperation (2 laparoscopic and 3 open surgery). The median length of hospital stay was 13 days. No patient experienced a relapse after treatment.

Abdominal pain, nausea, and vomiting were common symptoms in our study patients who underwent RPD. IH should be suspected if there is a positive finding on CT. Timely reoperation is necessary because IH may cause intestinal ischemia. Meticulous closure of the mesenteric defect is vital to avoid IH.

• colorectal surgery
• internal hernia
• laparoscopic colectomy
• small bowel obstruction
• volvulus

• Internal hernia
• Peritoneal defect
• Small bowel obstruction
• Vesico-uterine space

Internal hernia is the protrusion of an abdominal viscus through the peritoneum or mesentery into a compartment within the abdominal cavity. We present a case of internal herniation through the foramen of Winslow that was identified by CT imaging. It was treated with reduction at laparotomy and subsequent right hemicolectomy.

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We present a case of a concurrent Spigelian hernia and internal hernia through the falciform ligament.

Internal abdominal hernias account for 1% of all hernias but 5.8% of all bowel obstructions and hence are of significant clinical importance. Similarly Spigelian hernias account for only 0.12–2% of all abdominal wall hernias.

We present and discuss the management of a case that presented with concurrent falciform ligament internal abdominal hernia and Spigelian hernia. We believe this is the first reported case of such an occurrence in the literature.

Due to the advancements in computer topography (CT) imaging many internal and Spigelian hernias are diagnosed pre-operatively though these scan are not always available or indicated in cases of suspected small bowel obstruction. Due to the high mortality rate of undiagnosed internal hernias a high clinical suspicion must be maintained. The authors recommend laparoscopic trans-abdominal repair of Spigelian hernias in order to examine the abdominal contents and exclude rare, though potentially serious internal hernias.

• Abdominal wall
• Falciform ligament
• Hernia
• Internal hernia
• Spigelian

Transmesosigmoid hernia has previously been considered as a rare condition. The clinical symptoms can be nonspecific. Here, we report a case of acute intestinal obstruction because of transmesosigmoid hernia. In addition, after a comprehensive review of PubMed and China National Knowledge Infrastructure, we present a review of 22 cases of transmesosigmoid hernia. We summarize several valuable clinical features that help early recognition of transmesosigmoid hernia. As a result of easy strangulation, in patients without a history of surgery or abdominal inflammation who present with symptoms of progressive or persistent small bowel obstruction (SBO), surgeons should consider the possibility of transmesosigmoid hernia. In addition, based on our data, in patients with SBO because of transmesosigmoid hernia, the defect is usually 2-5 cm in diameter. Furthermore, because of the high risk of strangulation with transmesosigmoid hernia, it is mandatory to reassess the condition timely and periodically when patients receive conservative treatment.

• Transmesosigmoid hernia
• Acute intestinal obstruction
• Internal hernia

• Abdominal Pain/diagnosis
• Disease Progression
• Hernia/complications
• Herniorrhaphy
• Humans
• Inflammation
• Intestinal Obstruction/etiology
• Laparotomy
• Male
• Middle Aged
• Radiography, Abdominal
• Tissue Adhesions
• Tomography, X-Ray Computed
• Treatment Outcome

• Epiploic appendix
• Internal hernia
• Single-incision laparoscopic surgery (SILS)
• Small bowel obstruction