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Alahmed S, Brahmbhatt S, Meneghetti AT. Laparoscopic repair of a strangulated internal hernia through the hepatogastric ligament. J Surg Case Rep 2025; 2025:rjaf155. [PMID: 40181920 PMCID: PMC11967849 DOI: 10.1093/jscr/rjaf155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 03/03/2025] [Indexed: 04/05/2025] Open
Abstract
Internal hernias are a rare cause of small bowel obstruction, but they can lead to significant morbidity and mortality if left untreated, particularly in cases of strangulation. Herniation through the hepatogastric ligament, a component of the lesser omentum, is an exceedingly rare subtype. This report presents the case of a 44-year-old male who presented with worsening epigastric pain and was diagnosed with a strangulated internal hernia. Initial imaging with computed tomography (CT) suggested a closed-loop small bowel obstruction, with presumed herniation through the foramen of Winslow. Intraoperatively, the hernia was found to involve the hepatogastric ligament, a defect that was successfully repaired laparoscopically. This case highlights the pivotal role of CT imaging in the initial evaluation of internal hernias and the value of laparoscopy as both a diagnostic and therapeutic tool.
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Affiliation(s)
- Shayma Alahmed
- General Surgery Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaily Brahmbhatt
- General Surgery Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam T Meneghetti
- General Surgery Department, University of British Columbia, Vancouver, British Columbia, Canada
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Yin S, Li H, Xu J, Chen A, Di M, Hu X, Wang D, Wu X, Ai X, Liu W, Lei J, Qian Q, Ding J, Ren X, Jiang C. Risk factors of symptomatic internal hernias after left hemicolectomy: a multicenter retrospective study. Surg Endosc 2025; 39:2198-2210. [PMID: 39920374 DOI: 10.1007/s00464-025-11534-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 01/03/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND Mesenteric-related internal hernia after left hemicolectomy is rare. However, it can cause serious consequences, including upper gastrointestinal obstruction and acute intestinal necrosis. This study aimed to explore the potential risk factors of symptomatic internal hernia (SIH) after a left hemicolectomy. MATERIALS AND METHODS We retrospectively reviewed the data of patients who underwent a left hemicolectomy at 10 tertiary hospitals between January 2018 and June 2024. Their baseline information, surgical procedures, and early postoperative complications (within 3 months after surgery) were recorded and analyzed. RESULTS Overall, 468 patients were included in this study, the majority of patients underwent laparoscopic surgery (76.9%). SIH was detected using postoperative imaging (computed tomography/upper gastrointestinal contrast). Six patients (1.28%) developed SIH (SIH group) and underwent re-operation. Compared with the 462 patients who did not develop SIH (non-SIH group) (with comparable baseline data between groups), the SIH group did not undergo surgery to close the mesenteric defect (0 vs. 56.1%; p = 0.008) and had longer durations of postoperative hospital stay (50.5 ± 37.1 days vs. 14.6 ± 6.4 days; p < 0.001). Relative to the patients without mesenteric defect closure, those who had closure of the mesenteric defects did not have significantly increased duration of surgery (β = - 0.40, 95% CI = - 12.60 to 11.81, p = 0.949) or incidence of postoperative complications other than SIH (β = 0.79, 95% CI = 0.43 to 1.45, p = 0.443). CONCLUSION The risk of SIH after left hemicolectomy may increase if closure of the mesenteric defect is not performed. We recommend appropriate management of the mesenteric defect after left hemicolectomy to prevent SIH.
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Affiliation(s)
- Siyuan Yin
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, 430071, China
- Wuhan Clinical Research Center for Constipation and Pelvic Floor Disorders, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Haibo Li
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, China
| | - Jun Xu
- Department of Gastrointestinal Surgery, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, China
| | - Aijun Chen
- Department of Colorectal Surgery, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, China
| | - Maojun Di
- Department of Gastrointestinal Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Xiaoli Hu
- Department of Gastrointestinal Surgery, Qianjiang Central Hospital, Qianjiang, 433100, China
| | - Donghua Wang
- Department of Colorectal Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Xiangbo Wu
- Department of Colorectal Surgery, The Second People's Hospital of Yichang, Yichang, 443000, China
| | - Xu Ai
- Department of Colorectal Surgery, Jingmen No. 1 People's Hospital, Jinmen, 448000, China
| | - Wenming Liu
- Department of Gastrointestinal Surgery, The First People's Hospital of Tianmen, Tianmen, 431700, China
| | - Junping Lei
- Department of Colorectal Surgery, Xiangyang No. 1 People's Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, 430071, China
- Wuhan Clinical Research Center for Constipation and Pelvic Floor Disorders, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jianhua Ding
- Department of Colorectal Surgery, The Characteristic Medical Center of PLA Rocket Force, Beijing, 100088, China.
| | - Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China.
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China.
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, 430071, China.
- Wuhan Clinical Research Center for Constipation and Pelvic Floor Disorders, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Congqing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China.
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China.
- Quality Control Center of Colorectal and Anal Surgery, Health Commission of Hubei Province, Wuhan, 430071, China.
- Wuhan Clinical Research Center for Constipation and Pelvic Floor Disorders, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Kaw P, Behari A, Sharma S, Kumar A, Singh RK. Internal hernia as a rare cause of small bowel obstruction: An insight from 13 years of experience. World J Clin Cases 2025; 13:92254. [PMID: 40051799 PMCID: PMC11612681 DOI: 10.12998/wjcc.v13.i7.92254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 09/21/2024] [Accepted: 10/08/2024] [Indexed: 11/25/2024] Open
Abstract
BACKGROUND Internal hernia (IH) is a rare culprit of small bowel obstruction (SBO) with an incidence of < 1%. It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis, improper treatment, and subsequent morbidity and mortality. AIM To determine the clinico-demographic profile, radiological and operative findings, and postoperative course of patients with IH and its association with SBO. METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow, India between September 2010 and August 2023 were reviewed. RESULTS Out of 586 patients, 7 (1.2%) were diagnosed with IH. Among these, 4 had congenital IH and 3 had acquired IH. The male-to-female ratio was 4:3. The median age at presentation was 32 years. Contrast-enhanced computed tomography (CECT) was the most reliable investigation for preoperative identification, demonstrating mesenteric whirling and clumped-up bowel loops. Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency (approximately 43% each). Intraoperatively, one patient was found to have bowel ischemia and one had associated malrotation of gut. During follow-up, no recurrences were reported. CONCLUSION IH, being a rare cause, must be considered as a differential diagnosis for SBO, especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery. A rapid imaging evaluation, preferably with CECT, is necessary to aid in an early diagnosis and prompt intervention, thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
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Affiliation(s)
- Payal Kaw
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Supriya Sharma
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Rajneesh K Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
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Sah R, Rawal SB, Malla S, Rayamajhi J, Bhat PS. A left paraduodenal hernia causing bowel obstruction: a case report. J Surg Case Rep 2025; 2025:rjaf045. [PMID: 39931034 PMCID: PMC11809253 DOI: 10.1093/jscr/rjaf045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 01/21/2025] [Indexed: 02/13/2025] Open
Abstract
Paraduodenal hernias (PDHs) are rare congenital internal hernias, constituting 50% of internal hernias and 0.2%-0.9% of small bowel obstructions. Left PDHs are more common and arise from midgut malrotation during embryonic development. We present the case of a 59-year-old male with acute small bowel obstruction caused by a left PDH. Imaging revealed clustered small bowel loops in the left upper quadrant, a hallmark of left PDH. Diagnostic laparoscopy confirmed the condition but was converted to open surgery due to dense adhesions. The herniated loops, initially edematous, were viable after reduction and warm compression. The hernia orifice was closed with non-absorbable sutures. Early diagnosis using imaging, particularly CT, is crucial, with findings such as clustered bowel loops, displaced structures, and engorged mesenteric vessels converging at the hernia orifice. Surgical intervention is the definitive treatment, highlighting the importance of prompt recognition to prevent complications and ensure favorable outcomes.
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Affiliation(s)
- Raju Sah
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Sushil B Rawal
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Srijan Malla
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Jyoti Rayamajhi
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Pawan S Bhat
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
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Lamichhane S, Koirala S, khanal B. Strangulated left para-duodenal hernia: A case report and review of literature. Radiol Case Rep 2025; 20:629-631. [PMID: 39583226 PMCID: PMC11585467 DOI: 10.1016/j.radcr.2024.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 10/05/2024] [Indexed: 11/26/2024] Open
Abstract
Internal hernias are a rare entity with an incidence of 0.2%-0.9% among all hernias. Patients may present with a wide spectrum of symptoms, but strangulated para-duodenal hernias are relatively rare. We present a case of a 24-year-old male who presented with severe abdominal pain. He was diagnosed with a left para-duodenal hernia through contrast-enhanced computed tomography of the abdomen and pelvis. He underwent exploratory laparotomy followed by the resection of strangulated ileal loops with ileo-ileal anastomosis. Emergency surgery is the mainstay of management, and the approach to surgery, open vs. laparoscopic, depends on the surgeon's expertise and available infrastructure. The mortality rate is high if hernias are complicated by incarceration, strangulation, or obstruction.
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Affiliation(s)
| | - Sapana Koirala
- Department of Radiodiagnosis and Imaging, BPKIHS, Dharan, Nepal
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Soussan H, Taibi S, Guellil A, Jabi R, Bouziane M. Obstruction of the Bowel on an Inter-sigmoid Hernia: A Rare Cause of Occlusion. Cureus 2025; 17:e77996. [PMID: 40013180 PMCID: PMC11862862 DOI: 10.7759/cureus.77996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2025] [Indexed: 02/28/2025] Open
Abstract
Inter-sigmoid hernia is a rare condition characterized by the protrusion of the small intestine into the inter-sigmoid fossa. The inter-sigmoid fossa, also known as the inter-sigmoid recess, is a funnel-shaped peritoneal pouch of variable size, located between the two mesenteric roots of the parietal margin of the meso-sigmoid. The diagnosis of inter-sigmoid hernia is often delayed due to nonspecific clinical symptoms, which frequently leads to a postponement of surgical intervention. Preoperative detection on CT imaging can be challenging, and the diagnosis is typically confirmed during urgent surgical exploration. We report the case of a 63-year-old man who presented to the emergency room with abdominal pain. The physical examination and radiological findings were suggestive of an intestinal occlusion over an internal hernia. Given these findings, an emergency laparotomy was performed, confirming the diagnosis of an inter-sigmoid internal hernia with incarceration of a distended segment of the small intestine.
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Affiliation(s)
- Haitam Soussan
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed 1st University, Oujda, MAR
| | - Soufiane Taibi
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed 1st University, Oujda, MAR
| | - Abdelali Guellil
- Visceral Surgery and Digestive Oncology A, Mohammed VI University Hospital, Oujda, MAR
| | - Rachid Jabi
- Visceral Surgery, Mohamed VI University Hospital, Oujda, MAR
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Yodying H. Successful laparoscopic management of strangulated left paraduodenal hernia: A case report and review of minimally invasive approaches. Int J Surg Case Rep 2024; 125:110566. [PMID: 39571232 PMCID: PMC11617917 DOI: 10.1016/j.ijscr.2024.110566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 11/05/2024] [Indexed: 12/08/2024] Open
Abstract
INTRODUCTION Paraduodenal hernias are rare congenital anomalies that can lead to acute bowel obstruction and strangulation. Laparoscopic management of these complex cases in emergency settings remains challenging, particularly when bowel ischemia is present. CASE PRESENTATION We report a case of a 56-year-old woman presenting with acute small bowel obstruction due to a strangulated left paraduodenal hernia. Emergency laparoscopic surgery revealed ischemic bowel segments within the hernia sac. We utilized indocyanine green (ICG) fluorescence imaging to assess bowel perfusion intraoperatively, guiding our decision for bowel resection. The procedure involved hernia reduction, resection of non-viable bowel, and primary anastomosis, followed by hernia defect closure. Despite encountering a small bowel injury during reduction, we successfully completed the procedure laparoscopically. DISCUSSION This case demonstrates the feasibility of laparoscopic management for complicated paraduodenal hernias with bowel strangulation in emergency settings. The use of ICG imaging for real-time perfusion assessment represented a novel application in this context, aiding in the precise identification of ischemic bowel segments requiring resection. CONCLUSION Laparoscopic repair of strangulated paraduodenal hernias is feasible and effective, even in emergency scenarios. The integration of advanced imaging techniques like ICG fluorescence may enhance intraoperative decision-making, particularly in assessing bowel viability. This approach potentially reduces the extent of bowel resection and improves outcomes in these complex cases.
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Affiliation(s)
- Hariruk Yodying
- Department of Surgery, HRH Princess MahaChakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, 62 Ongkharak, Nakhon Nayok 26120, Thailand.
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Mishra C, Omar KO. Internal Hernia: An Uncommon and Often-Missed Differential Diagnosis of Abdominal Pain. Cureus 2024; 16:e75801. [PMID: 39822468 PMCID: PMC11735237 DOI: 10.7759/cureus.75801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2024] [Indexed: 01/19/2025] Open
Abstract
Abdominal pain is a common presenting symptom among patients visiting the hospital. A wide range of differential diagnoses are associated with this presentation, some of which are more uncommon than others, and require a higher degree of clinical suspicion and radiological excellence to diagnose. Although clinicians rely on physical assessment, examining a patient who is agitated and non-cooperative sometimes limits the physical exam findings, making these diagnoses even more challenging. We present a case of a middle-aged male patient who had acute abdominal pain in the setting of polysubstance abuse as confirmed by a drug screen. His initial imaging was unremarkable for a cause and the patient was intubated. After intubation and sedation, his physical examination was benign. He was extubated the next day and complained of worsening abdominal pain. His physical exam then was concerning for an acute abdomen and upon review of the initial imaging, a missed diagnosis of internal hernia was established. The patient subsequently underwent emergent exploratory laparotomy and a large section of the bowel was resected. This case highlights the importance of considering alternate diagnoses for common presentations and paying careful attention to classic radiology findings in these situations.
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Affiliation(s)
- Chaitanya Mishra
- Division of Pulmonary Critical Care Medicine, Charleston Area Medical Center, Charleston, USA
| | - Khawaja O Omar
- Division of Pulmonary Critical Care Medicine, Charleston Area Medical Center, Charleston, USA
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Thi Thanh Tam B, Ba Hong Phong L, Nguyen Thuan H, Vo Cong Nguyen D, Thanh Toan V, Dinh Thanh L. Internal hernia with small bowel obstruction caused by Meckel's diverticulum: A case report. Radiol Case Rep 2024; 19:5342-5345. [PMID: 39280735 PMCID: PMC11401067 DOI: 10.1016/j.radcr.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 09/18/2024] Open
Abstract
We report a case of small bowel obstruction (SBO) caused by internal hernia from Meckel's diverticulum (MD). Abdominal CT scan showed an abnormal dilated blind-ending structure in continuity with the distal ileum in the right lower quadrant, suggesting Meckel's diverticulum. MPR images revealed a "double beak-sign" at the point of MD and a collapsed closed loop with mesenteric vessels converging to the diverticulum. Since the patient has no prior history of abdominal surgery, the diagnosis of internal hernia caused by Meckel's diverticulum was considered. On laparoscopic exploration, an abnormal orifice for internal hernia created by adhesion from the tip of Meckel's diverticulum to the adjacent mesentery was revealed, confirming the diagnosis. The patient was discharged after 7 days without postoperative complications. MD-associated internal hernia is a rare cause of small bowel obstruction and should be considered to avoid delay in treatment. Multidetector Computed Tomography (MDCT) is the first-line imaging modality of choice and may offer some suggestive imaging features to make an accurate preoperative diagnosis.
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Pal NL, Panandiker SD, Katiyar G, Vernekar JA. Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist. Emerg Radiol 2024; 31:733-748. [PMID: 38926239 DOI: 10.1007/s10140-024-02256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.
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Affiliation(s)
- Nilkanth L Pal
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India.
| | - Swamini D Panandiker
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Glory Katiyar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Jeevan A Vernekar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
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Tavasolizadeh M, Dalili A. An incarcerated paraduodenal hernia of a malrotated gut in a 26-year-old man. Int J Surg Case Rep 2024; 122:110055. [PMID: 39043095 PMCID: PMC11318467 DOI: 10.1016/j.ijscr.2024.110055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction and importance: Paraduodenal hernias (PDHs) are congenital internal hernias. Overall, internal hernias are between 0.2 % and 0.9 %, while 53 % of these statistics are for PDH. There are left and right types of PDHs. CASE PRESENTATION An otherwise healthy 26-year-old man was presented with a sudden-onset epigastric and right upper quadrant abdominal pain. Abdominopelvic double contrasted CT scan revealed multiple dilated proximal-mid small bowel loops in the portal venous phase consistent with small bowel obstruction, suggesting concomitant bowel malrotation with internal paraduodenal hernia. The patient with the pre-operative diagnosis of small bowel obstruction due to volvulus was scheduled for emergency surgery. He was four weeks complication-free in his regular follow-up. CLINICAL DISCUSSION In 1857, Treitz first described PDH as a phenomenon when the primitive midgut in embryonic life abnormally rotates and causes mesocolic hernia. The location of the duodenal recess is the origin point for describing the hernia; thus, the jejunum is the most common herniating viscus. However, the stomach, small intestine, and sometimes the colon usually consist of the contents of the hernia. CONCLUSION In the absence of surgical history, abdominal wall hernia, and intra-abdominal inflammatory disease, in case of repeated abdominal pain or intestinal obstruction, and if no other causes are found, the possibility of a PDH should be kept in mind.
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Affiliation(s)
- Morteza Tavasolizadeh
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of General Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amin Dalili
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of General Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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Panthi A, Thapaliya I, Khadka L, Bhusal M, Dev S, Jha SK, Neupane A, Sah JK. The role of computed tomography in acute bowel obstruction due to a supravesical hernia: a case report from Nepal. Ann Med Surg (Lond) 2024; 86:4268-4273. [PMID: 38989232 PMCID: PMC11230816 DOI: 10.1097/ms9.0000000000002222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/16/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction and importance Supravesical hernias are rare internal hernias but potential cause of small-bowel obstruction. The clinical features are often non-specific, preoperative diagnosis is very difficult and is often diagnosed intraoperatively. The exact pathogenesis is unclear with the major risk factors of prematurity, a positive family history, male sex, smoking habits leading to decreased collagen production, advancing age, and conditions characterized by defective collagen synthesis. Case presentation The authors are reporting a case of small-bowel obstruction secondary to a supravesical hernia, in a 78-year-old male presented with central abdominal pain, vomiting and obstipation. Ultrasonography of the abdomen and pelvis identified a marked dilation of the small-bowel loop with multiple loops of dilated jejunum and ileum in contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis with lead point from the terminal ileum. Exploratory laparotomy was done with the diagnosis of left posterior a left posterior superior vesical hernia with small-bowel obstruction. Clinical discussion The case focuses supravesical hernia as a rare yet life-threatening etiology of small-bowel obstruction, emphasizing the importance of clinical suspicion when patients present with signs and symptoms of bowel obstruction. While diagnosis often occurs intraoperatively, the utilization of CT scans in emergency settings can provide valuable insights into the location, potential causes, and condition of the herniated bowel sac. The case highlights the pivotal role of CT scans in diagnosis and emphasizes the need for multidisciplinary cooperation among clinicians, radiologists, and surgeons. Conclusion Early intervention ensures better outcomes and prevents irreversible bowel damage, underscoring the importance of a comprehensive approach to patient care.
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Affiliation(s)
| | | | | | - Madhav Bhusal
- Devdaha Medical College, Devdaha, Bhaluhi, Rupandehi, Nepal
| | | | | | | | - Jayant Kumar Sah
- Department of General Surgery, Institute of Medicine, Maharajgunj
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Khedr S, Abdelmohsen SM, Abdelazim O. Mesocolic hernia, a case series. Int J Surg Case Rep 2024; 119:109696. [PMID: 38714067 PMCID: PMC11098949 DOI: 10.1016/j.ijscr.2024.109696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Paraduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature. CASE PRESENTATION Four male and one female child complained of paraduodenal hernias, two on the right side and three on the left side. The intestinal part that herniated inside the hernia sac was also malrotated in four patients. One patient had Meckel's diverticulum with a herniated intestine. One infant had extrahepatic biliary disease, a single atrium, polysplenia, intestinal malrotation, and a left paraduodenal hernia. Exploratory labarotomy was done for reduction of the intestine, reorientation, and repair of hernia orifices. CLINICAL DISCUSSION Paraduodenal hernia is a component of malrotation. Cautious dissection of the hernia orifice is required to keep away from injuries to the inferior mesenteric vein or left colic artery in the course of the restoration of the left paraduodenal hernia. Also, the superior mesenteric vessels may be injured in the course of the restoration of the right paraduodenal hernia. CONCLUSION There is a correlation between the occurrence of PDH with malrotation. The diagnosis of malrotation can be made with an ultrasound abdomen; however, it is true that ultrasound cannot make a confirmed diagnosis in all patients. Once the diagnosis of a mesocolic hernia has occurred, surgical repair is mandatory by closure of the defect.
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Affiliation(s)
- Sayed Khedr
- Lecturer of Pediatric Surgery at Cairo University Children Hospital, Cairo University, Egypt
| | | | - Osama Abdelazim
- Lecturer of Pediatric Surgery at Cairo University Children Hospital, Cairo University, Egypt
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14
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Nguyen BH, Mcguirt AS. Radiographic Features of a Strangulated Transomental Hernia. Cureus 2024; 16:e62484. [PMID: 39022475 PMCID: PMC11251898 DOI: 10.7759/cureus.62484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
This is a case report of an 82-year-old male who presented with intractable and diffuse abdominal pain and had a computed tomography (CT) abdomen showing a closed loop obstruction in the right hemiabdomen with anteromedial displacement of the cecum and ascending colon. Exploratory laparotomy revealed a gangrenous segment of the ileum strangulated by a transomental hernia in the right lower quadrant. The nonviable bowel was resected, and the healthy bowel segments were anastomosed. It is important to correlate the clinical signs of bowel obstruction with radiographic findings of internal hernia to expedite surgical intervention and prevent complications of bowel ischemia.
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Affiliation(s)
- Bao H Nguyen
- General Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Aron S Mcguirt
- General Surgery, Bay Pines VA Health Care system, St. Petersburg, USA
- General Surgery, University of Central Florida College of Medicine, Orlando, USA
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15
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Ogunleye O, Abdelhafez AH, Matta E, Kramer L. Retrorectal Hernia: A Rare Cause of Constipation Diagnosed on Magnetic Resonance (MR) Defecography. Cureus 2024; 16:e58848. [PMID: 38784319 PMCID: PMC11112525 DOI: 10.7759/cureus.58848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Retrorectal herniation of the sigmoid colon is a rare condition characterized by the protrusion of a segment of the colon into the pre-sacral space and posterior to the rectum. This herniation occurs through a defect in the peritoneum, which may have developed secondary to congenital mechanisms, surgery, trauma, or inflammatory processes. Here, a case of retrorectal herniation of the sigmoid colon in an elderly female patient presenting with constipation is reported, with a review of the literature.
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Affiliation(s)
- Olanrewaju Ogunleye
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
| | - Abeer H Abdelhafez
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
| | - Eduardo Matta
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
| | - Larry Kramer
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
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16
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Del Cerro Rodríguez D, González-Pola Yuncal S, Altamirano S, García Saavedra S, Gómez Tellado M. [A case of abdominal internal hernia through the foramen of Winslow in a pediatric emergency department]. An Sist Sanit Navar 2024; 47:e1068. [PMID: 38488072 PMCID: PMC10933693 DOI: 10.23938/assn.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
Abdominal internal hernia is a rare cause of intestinal obstruction in pediatric emergency departments, being the herniation through the foramen of Winslow an exceptional entity (less than 0.5% of the herniae). We report the case of a 15-year-old adolescent male without previous surgical interventions who presented with abdominal pain and vomiting; computed tomography scans showed intestinal obstruction due to an internal hernia through the foramen of Winslow. To reduce the herniated ileum, the patient required surgical intervention with diagnostic laparoscopy, which, due to bad visualization, was changed to supraumbilical midline laparotomy. There was no need to resect the affected ileum as it appeared healthy. We did not perform a preventive technique to reduce the risk of recurrence. Postoperative pelvic collection was conservatively managed with antibiotics. The patient undergoes regular follow-up in the pediatric surgery department.
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17
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Devi P, Hatgaonkar A, Tanksale V, Dhawan V, Kamble A, Jobanputra M. A Case Report on Internal Hernia as an Unusual Cause of Small Bowel Obstruction: A Diagnostic Triumph Unveiled by Computed Tomography Scan. Cureus 2024; 16:e55526. [PMID: 38576692 PMCID: PMC10992731 DOI: 10.7759/cureus.55526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Paraduodenal hernia is a type of internal hernia caused by defects in the peritoneum during fetal development. It is one of the uncommon causes of intestinal obstruction; diagnosing it and intervening promptly are required. In this case report, we describe our experience treating an adult male patient who presented with symptoms of acute small bowel obstruction and was later diagnosed with internal hernia on further evaluation. The purpose of this case report is to demonstrate the importance of imaging modalities, particularly computed tomography (CT) scan, in diagnosing these cases. Because of their mysterious symptoms, paraduodenal hernias are usually diagnosed late or incidentally. Although they are uncommon, they are far more likely to cause bowel obstruction and strangulation. Immediate surgical intervention is required following the diagnosis.
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Affiliation(s)
- Pavithra Devi
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anand Hatgaonkar
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | | | - Vaishali Dhawan
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Akhilesh Kamble
- General Surgery, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Meet Jobanputra
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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18
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Kikhlyarov PV, Murvatova KK, Yunusov AA. [Strangulated hernia of the foramen of Winslow complicated by acute colonic obstruction]. Khirurgiia (Mosk) 2024:92-95. [PMID: 39140949 DOI: 10.17116/hirurgia202408192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.
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Affiliation(s)
- P V Kikhlyarov
- Davydovsky Moscow City Clinical Hospital, Moscow, Russia
| | - K K Murvatova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Yunusov
- Davydovsky Moscow City Clinical Hospital, Moscow, Russia
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19
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Wang XL, Jin GX, Xu JF, Chen ZR, Wu LM, Jiang ZL. Right paraduodenal hernia, classification, and selection of surgical methods: a case report and review of the literature. J Med Case Rep 2023; 17:536. [PMID: 38158564 PMCID: PMC10757357 DOI: 10.1186/s13256-023-04286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Considering that right paraduodenal hernia is a rare internal hernia with abnormal anatomy and is often encountered during an emergency, surgeons may lack knowledge about it and choose incorrect treatment. Thus, this case report is a helpful complement to the few previously reported cases of right paraduodenal hernia. Additionally, we reviewed all the reported right paraduodenal hernia cases and proposed appropriate surgical strategies according to different anatomical features. CASE PRESENTATION The case involved a 33-year-old Chinese male patient who was admitted to the hospital due to abdominal pain. The patient was initially diagnosed with small bowel obstruction, and conservative treatment failed. An emergency operation was arranged, during which a diagnosis of right paraduodenal hernia was made instead. After surgery, the patient recovered well without abdominal pain for 2 years. CONCLUSION Although right paraduodenal hernia accounts only for a small proportion of paraduodenal hernia, its anatomical characteristics can vary considerably. We divided right paraduodenal hernia into three types, with each type requiring a different surgical strategy.
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Affiliation(s)
- Xiao-Long Wang
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Gui-Xiu Jin
- Department of Gynecology and Obstetrics, Taixing People's Hospital, Taixing, Jiangsu, China
| | - Jian-Feng Xu
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China
| | - Zhi-Rong Chen
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China
| | - Li-Meng Wu
- Department of Radiology, Taixing People's Hospital, Taixing, Jiangsu, China
| | - Zhi-Long Jiang
- Department of General Surgery, Taixing People's Hospital, No. 1, Changzheng Road, Taixing, Jiangsu, China.
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20
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Matsuishi K, Saito S, Ohuchi M, Kiyozumi Y, Nasu J, Hanada N, Baba H. A case of internal hernia in the pararectal fossa. Surg Case Rep 2023; 9:178. [PMID: 37843687 PMCID: PMC10579196 DOI: 10.1186/s40792-023-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/02/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Internal hernias are relatively rare and difficult to diagnose. Diagnostic delays lead to the progression of strangulation. In particular, pararectal fossa hernias are extremely rare. We encountered a case in which internal hernia occurred in the pararectal fossa. CASE PRESENTATION An 87-year-old woman was referred to our hospital because of persistent lower abdominal pain and vomiting. Contrast-enhanced computed tomography revealed findings of intestinal ischemia, such as closed loop formation with reduced contrast effect on the left side of the rectum in the pelvis. Strangulation small bowel obstruction was diagnosed, and emergency laparotomy was performed. The small intestine was found to invade the peritoneal reflection on the left side of the rectum. The patient was finally diagnosed with pararectal fossa hernia. The incarcerated small intestine was released with no bowel resection. The 4-cm hernia phylum was observed and closed by simple suture. The patient had a good postoperative course without recurrence. CONCLUSIONS We encountered a very rare case of internal hernia in the left pararectal fossa. Preoperative diagnosis of this disease is difficult, but it should nevertheless be considered in cases in which the cause of the intestinal obstruction is unknown.
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Affiliation(s)
- Kozue Matsuishi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Seiya Saito
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Mayuko Ohuchi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Yuki Kiyozumi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Jiro Nasu
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Norihisa Hanada
- Department of Surgery, Izumi General Medical Center, 520 Myozincho, Izumi City, Kagoshima, 899-0131, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
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21
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Hina A, Zahid MJ, Jan MA, Haseeb A, Hussain M. From Recurrent Pain to a Life-Threatening Condition: A Case Report of Left Paraduodenal Hernia. Cureus 2023; 15:e42596. [PMID: 37641743 PMCID: PMC10460500 DOI: 10.7759/cureus.42596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Paraduodenal hernia (PDH) is the most frequent type of congenital hernia, especially on the left side. Although acute intestinal obstruction due to internal hernias is rare, it can be life-threatening if not detected and treated promptly. Here, we present the case of a 36-year-old man who presented to the emergency department with an acute intestinal obstruction that had been developing for three days. The patient had a history of recurrent abdominal pain but had never undergone any abdominal surgery. Surgical exploration revealed a left internal PDH with a collection of incarcerated jejunal loops retrocolically encased within the hernial sac. Resection of the gangrenous jejunal loops was performed, followed by hernia reduction and neck closure. This case highlights the importance of timely and accurate diagnosis of left PDHs, particularly in patients with a history of recurrent abdominal pain and no prior abdominal surgeries. Early detection and treatment can prevent life-threatening complications such as intestinal perforation and peritonitis.
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Affiliation(s)
- Ayesha Hina
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | | | - Abdul Haseeb
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Musarrat Hussain
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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22
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Massive intraperitoneal effusion caused by a rare disease. Asian J Surg 2023; 46:1366-1367. [PMID: 36153268 DOI: 10.1016/j.asjsur.2022.08.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
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23
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Muacevic A, Adler JR, Zia BF, Ashraf A, Khawar A. Chylous Ascites Pointing Toward an Internal Hernia in the Setting of Roux-en-Y Gastric Bypass: A Case Report. Cureus 2023; 15:e33857. [PMID: 36819359 PMCID: PMC9934932 DOI: 10.7759/cureus.33857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Chylous ascites is a rare but significant complication of a variety of surgical procedures. It is an uncommon complication of laparoscopic Roux-en-Y gastric bypass (LRGYB). The underlying etiology is assumed to be an internal hernia, in which the hernia causes lymphatic channel engorgement and lymphatic extravasation. We present the case of a 34-year-old male who had a history of LRGYB a year back and had been experiencing gradually worsening, colicky abdominal pain radiating to the right flank for the last 24 hours. Laparoscopic exploration revealed chylous ascites due to internal herniation owing to the complication of LRYGB. Classic signs of internal hernias such as mesenteric swirl were absent on the computed tomography scan of the abdomen.
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24
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Lamprou V, Krokou D, Karlafti E, Panidis S, Kougias L, Tzikos G, Ioannidis A, Netta S, Thomaidou E, Paramythiotis D. Right Paraduodenal Hernia as a Cause of Acute Abdominal Pain in the Emergency Department: A Case Report and Review of the Literature. Diagnostics (Basel) 2022; 12:2742. [PMID: 36359585 PMCID: PMC9689437 DOI: 10.3390/diagnostics12112742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 01/27/2024] Open
Abstract
Paraduodenal hernias (PDHs) represent an unusual cause of acute abdominal pain in the Emergency Department (ED) and are associated with high morbidity attributable to a challenging clinical and radiological diagnosis, as signs and symptoms mimic other frequent causes of acute abdominal pain. We report a right paraduodenal hernia in a 37-year-old female patient who presented to the ED complaining of abdominal pain located in the right lower abdomen and hypogastrium, accompanied by nausea. During diagnostic work up, the abdominal computed tomography scan revealed the presence of small bowel malrotation with concomitant right paraduodenal hernia. These findings were confirmed intraoperatively. We performed a brief literature review about the clinical manifestations and treatment options of right paraduodenal hernias, which retrieved only 30 articles related to this condition. Prompt diagnosis, radiological or intraoperative, of paraduodenal hernias is crucial because nearly 50% will progress to small bowel obstruction. Therefore, it is essential for every clinician to account for them in the differential diagnosis of acute abdominal pain in the ED.
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Affiliation(s)
- Viktoria Lamprou
- Radiology Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Despoina Krokou
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stavros Panidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Leonidas Kougias
- Department of Interventional Radiology, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Georgios Tzikos
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Aristeidis Ioannidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Smaro Netta
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Evanthia Thomaidou
- Department of Anesthesia and Intensive Care, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Daniel Paramythiotis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
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25
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Chan WK, Chen YLR, Mohd Noor NA, Lim KT. Intra-mesosigmoid hernia: laparoscopic management of a rare case of internal hernia. ANZ J Surg 2022; 92:2720-2721. [PMID: 35470545 DOI: 10.1111/ans.17711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Wai Kiu Chan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | | | | | - Kheng Tian Lim
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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26
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Mulkey E, Stewart G, Enrique E, El-Sabrout R. Large bowel obstruction secondary to a cecal bascule with internal herniation through the foramen of Winslow: A case report. Int J Surg Case Rep 2022; 94:107123. [PMID: 35658294 PMCID: PMC9077526 DOI: 10.1016/j.ijscr.2022.107123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction Presentation of case Discussion Conclusion
Internal hernias through the foramen of Winslow are uncommon, and even more so with a concomitant cecal bascule. Expediting a CT scan of the abdomen and pelvis is vital to prevent a delay in diagnosis and progression to ischemic bowel. Surgery is the mainstay treatment of a foramen of Winslow internal hernia and often involves a right hemicolectomy.
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27
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Sajid NW, AlAnazi MOA, AlAnazi THM, AlKahtani ASA, AlRakhimi ASO. Intestinal Obstruction as a Postoperative Complication, A Narrative Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/0gnzzmmf5f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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28
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Youn SI, Kim DW, Jee YS. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac003. [PMID: 35178242 PMCID: PMC8846942 DOI: 10.1093/jscr/rjac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/01/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Sang Il Youn
- Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Dong-Wook Kim
- Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Ye Seob Jee
- Correspondence address. Department of Surgery, Dankook University College of Medicine, 201, Manghyangro, Dongnam-gu, Cheonan, 31116, Republic of Korea. Tel: +82-41-550-6379; Fax: +82-41-550-3928; E-mail:
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29
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Agrawal P, Grab JT, Howe HR, Cross K. Ruptured Ovarian Cyst Masking Diagnosis of Hernia Through Broad Ligament of Uterus: A Case Report. J Investig Med High Impact Case Rep 2022; 10:23247096221100500. [PMID: 35610939 PMCID: PMC9136441 DOI: 10.1177/23247096221100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/21/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022] Open
Abstract
Small bowel obstruction is a common surgical emergency and frequent cause of hospitalization. Internal hernias account for less than 6% of all small bowel obstruction cases. Less frequently, hernias through the broad ligament of the uterus can occur and account for only 4-7% of total internal hernia cases. We report a case of a small bowel hernia through broad ligament of the uterus in a young female. Multiple diagnostic modalities suggested a ruptured ovarian cyst as the most probable cause for her abdominal pain. However, her symptoms were much more severe than an ovarian cyst would normally produce. Therefore, a diagnostic laparotomy was performed, which found a small intestine hernia through the left broad ligament of the uterus. The diagnosis of intestinal hernias, specifically through the broad ligament, is often delayed due to the infrequent occurrence, varied presentation, and difficulty of confirmation on computed tomography (CT) scan. Surgery is the gold standard for the diagnosis and treatment of internal hernias. This article draws attention toward a rare and potentially life-threatening cause of abdominal pain.
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Affiliation(s)
- Pankaj Agrawal
- Department of Medicine, South Georgia Medical
Center, Valdosta, GA, USA
| | - John T. Grab
- Edward Via College of Osteopathic Medicine,
Auburn, AL, USA
| | - Harold R. Howe
- Department of General Surgery, South Georgia
Medical Center, Valdosta, GA, USA
| | - Kimberly Cross
- Department of Obstetrics and Gynecology,
South Georgia Medical Center, Valdosta, GA, USA
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Mohakud S, Naik S, Deep N, Singh A, Mishra TS, Sinha M. Transmesenteric Internal Abdominal Hernia: Multi-detector row computed tomography findings. Sultan Qaboos Univ Med J 2021; 21:502-503. [PMID: 34522423 PMCID: PMC8407917 DOI: 10.18295/squmj.4.2021.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arshdeep Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tushar S Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mithilesh Sinha
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Rajput D, Rai A, Gupta A, Chezhian S, Kumar S, Kundal A. Left Paraduodenal Hernia Presenting as Closed Loop Jejunal Obstruction in a Young Female: An Enigmatic and Perilous Differential of Acute Abdomen. Surg J (N Y) 2021; 7:e212-e215. [PMID: 34485697 PMCID: PMC8410239 DOI: 10.1055/s-0041-1733989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 06/11/2021] [Indexed: 12/03/2022] Open
Abstract
Internal hernia is a rare cause of intestinal obstruction, accounting for <2% of cases with paraduodenal type being the most common. An internal hernia, mostly acquired, develops due to protuberance of the intestine through a gap in the peritoneum or mesentery formed as a result of an antecedent abdominal operation such as gastric bypass or liver transplant, ischemic injury, peritonitis, or trauma. Paraduodenal hernias (PDHs) are congenital anomalies, secondary to a failed fusion of mesentery with parietal peritoneum along with rotational midgut errors, causing the evolution of potential space for herniation within the left paraduodenal fossa. Primary internal hernias can have a varied clinical presentation and cause significant mortality and morbidity if left untreated. We report the case of a 20-year-old female with chronic pain in abdomen and intestinal obstruction due to left PDH (LPDH). The prompt diagnosis led to timely exploration and reduction of entrapped jejunum, with prudent closure of the hiatus, while circumventing any injury to the adjacent mesenteric circulation. No postoperative ileus arose, and recovery was uneventful.
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Affiliation(s)
- Deepak Rajput
- Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Ankit Rai
- Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Amit Gupta
- Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Subramanian Chezhian
- Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Shashank Kumar
- Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Ashikesh Kundal
- Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
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Terra C, Ramos-Andrade D, Sá-Marques I, Brito J, Caseiro-Alves F, Curvo-Semedo L. Duodenal imaging on the spotlight: from A to Z. Insights Imaging 2021; 12:94. [PMID: 34232417 PMCID: PMC8263847 DOI: 10.1186/s13244-021-01045-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022] Open
Abstract
Abdominal computed tomography (CT) is frequently performed to evaluate gastrointestinal pathologic conditions. The majority of the gastrointestinal radiology literature has concentrated on the colon, stomach, and distal small bowel. The duodenum is often overlooked on imaging, namely on CT, but its anatomy (intra and retroperitoneal) and location in such close proximity to other viscera results in involvement by a multitude of primary and secondary processes, some of them exclusive to this bowel segment. While some conditions, like duplications, lipomas, and diverticula, are usually asymptomatic and are incidentalomas that have no pathologic significance, others are symptomatic and very relevant and should be recognized by every general radiologist: development conditions such as annular pancreas and gut malrotation; inflammatory processes such as ulcers and secondary involvement from pancreatitis; neoplastic conditions such as adenocarcinoma, lymphoma, or local extension from adjacent malignancies. They all can be reliably diagnosed with CT. In this article, we demonstrate the typical imaging features of various diseases involving the duodenum, such as developmental, traumatic, inflammatory, infectious, neoplastic, and postsurgical pathologic conditions in alphabetical order, focusing mainly on upper gastrointestinal series (UGIS) and CT but also some radiography, ultrasound, and magnetic resonance (MR) imaging.
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Affiliation(s)
- Carolina Terra
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Daniel Ramos-Andrade
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Ivo Sá-Marques
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Jorge Brito
- Centro Hospitalar do Algarve, Faro, Portugal
| | - Filipe Caseiro-Alves
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
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[A Case Report of Lateral Paracecal Hernia Treated with Single Port Surgery]. J UOEH 2021; 43:277-282. [PMID: 34092773 DOI: 10.7888/juoeh.43.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An 86-year-old female hospitalized for right femoral fracture complained of a sudden abdominal pain and vomited. Contrast-enhanced computed tomography (CECT) of the abdomen showed an ileal closed loop with dilatation of the oral side intestine. She was diagnosed with a bowel obstruction due to a paracecal hernia with incarceration and underwent an emergency operation. Under laparoscopy, the responsible ileum was incarcerated into the paracolic sulcus and strangulated. After releasing the strangulation by cutting the hernia hilum, the incarcerated ileum did not show any necrotic change. In this case, the CECT suggested paracecal hernia, showing the characteristic position between the cecum and the intestinal loop, which we successfully treated with a single incisional laparoscopic surgery.
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Retrocecal hernia: A case report. Ann Med Surg (Lond) 2021; 66:102390. [PMID: 34040774 PMCID: PMC8141675 DOI: 10.1016/j.amsu.2021.102390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/30/2021] [Accepted: 05/09/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Retroperitoneal Retrocecal hernias are a rare variety of internal hernias and represent an unusual cause of bowel obstruction. Early diagnosis is based on CT scan and requires knowledge of the pathology in order to avoid small bowel resection. We report a case of retrocecal hernia treated surgically and review the characteristics and treatment of retrocecal hernias in the literature. Materials and methods Our work is a retrospective case report with a descriptive aim concerning a patient operated for retrocecal hernia within the department of general surgery of CHU Ibn Rochd Casablanca. Case report A 72-year-old man presented to the emergency department with abdominal pain and vomiting that have been evolving for 9 days complicated by an occlusive syndrome 36 hours before the admission. The patient was apyretic, and the abdominal examination noted abdominal meteorism predominantly in the right iliac fossa, absence of abdominal scarring, and free hernial orifices. The abdominal X-ray showed air-fluid levels and the abdominopelvic CT scan found clumping of the dilated small intestines posteriorly and below the cecum. The diagnosis of retrocecal hernia was suspected and the patient was taken to the operating room. The operation was performed by laparotomy through a midline incision. On exploration, the cecum and ascending colon were pushed forward and viable bowel loops were incarcerated in a fossa located posteriorly and below the cecum. The procedure consisted of a collapse of the retrocecal ligaments by right coloparietal collapse. Conclusion A bowel obstruction in an apyretic patient without abdominal scarring or parietal hernia should suggest the diagnosis of internal hernia, which must be investigated.
Retrocecal hernias are a rare variety of internal hernias and represent an unusual cause of bowel obstruction. Early diagnosis is based on CT scan and requires knowledge of the pathology. The procedure consisted of a collapse of the retrocecal ligaments by right coloparietal collapse. We report the case of a retrocecal hernia in an elderly man and describe the anatomy and the characteristic features of this pathology.
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Kelahan L, Menias CO, Chow L. A review of internal hernias related to congenital peritoneal fossae and apertures. Abdom Radiol (NY) 2021; 46:1825-1836. [PMID: 33128101 DOI: 10.1007/s00261-020-02829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023]
Abstract
Congenital-type internal hernias have the potential to cause small bowel obstruction well into adulthood. Congenital-type internal hernias include left paraduodenal, right paraduodenal, foramen of Winslow, pericecal, sigmoid mesocolon, transomental, small bowel mesentery, and broad ligament hernias. This review summarizes CT imaging features and complications of congenital internal hernias using a systematic approach based on abdominopelvic quadrants and key anatomic features. CT imaging will continue to be commonly used to evaluate abdominal pain. Anatomical landmarks and characteristic CT findings can help identify congenital internal hernias as a potential cause of abdominal pain.
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Affiliation(s)
- Linda Kelahan
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Lawrence Chow
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
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36
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The beak sign of foramen of Winslow hernia. Abdom Radiol (NY) 2021; 46:2261-2262. [PMID: 33247767 DOI: 10.1007/s00261-020-02878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
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Honma S, Itohara T, Sha S, Onoyama H. Laparoscopic surgery in a patient with foramen of Winslow hernia due to large uterine fibroids: a case report and literature review. Surg Case Rep 2021; 7:77. [PMID: 33768335 PMCID: PMC7994464 DOI: 10.1186/s40792-021-01162-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/21/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Foramen of Winslow hernia (FWH) is a rare but emergent condition caused by an increase in the foramen diameter, visceral mobility, and intra-abdominal pressure. To the best of our knowledge, this is the first study to report a case of FWH secondary to large uterine fibroids that was successfully treated with laparoscopic surgery. CASE PRESENTATION A 52-year-old woman with large uterine fibroids was diagnosed with FWH. Because of the absence of signs of bowel ischemia and peritonitis, we performed an elective laparoscopic surgery through a 5-port system after bowel decompression using a long intestinal tube. Although foramen of Winslow closure was not performed, her postoperative course was uneventful. CONCLUSIONS Laparoscopic surgery for FWH is considered an extremely effective surgical treatment option because of its safety and efficacy in performing delicate procedures (such as adhesiolysis) with a good magnified field of view.
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Affiliation(s)
- Shusaku Honma
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo, 653-0013, Japan.
| | - Takenori Itohara
- Department of General Medicine, Nozaki Tokushukai Hospital, 2-10-5, Tanigawa, Daito, Osaka, 574-0074, Japan
| | - Seigo Sha
- Department of General Medicine, Nozaki Tokushukai Hospital, 2-10-5, Tanigawa, Daito, Osaka, 574-0074, Japan
| | - Hirohiko Onoyama
- Department of General Medicine, Nozaki Tokushukai Hospital, 2-10-5, Tanigawa, Daito, Osaka, 574-0074, Japan
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38
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Bowel ultrasonography in acute abdomen: Beyond acute appendicitis. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vanmali A, Maharajh J, Haines M. Left paraduodenal hernia: Embryological and radiological findings. SA J Radiol 2021; 25:1979. [PMID: 33824740 PMCID: PMC8007996 DOI: 10.4102/sajr.v25i1.1979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022] Open
Abstract
Left paraduodenal hernia (PDH), may present as a surgical emergency with an increased risk of strangulation and incarceration. The diagnosis is challenging because of the non-specific presentation. In the absence of common epigastric or upper abdominal pathology and non-resolving symptoms, a high index of suspicion is required to diagnose left PDH. This report describes a case of radiologically diagnosed left paraduodenal hernia and subsequent successful surgery. It also includes a review of midgut embryology, and the anatomy and radiology of left PDH.
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Affiliation(s)
- Atish Vanmali
- Jackpersad and Partners Inc., Private Practice, Durban, South Africa
| | - Jaynund Maharajh
- Department of Radiology, Faculty of Medicine, King Edward VIII Hospital, Durban, South Africa
| | - Mario Haines
- Jackpersad and Partners Inc., Private Practice, Durban, South Africa
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40
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Payonk EA, Williams RJ. More than just gastritis: An unusual presentation of strangulated transmesenteric hernia in a pediatric patient. Am J Emerg Med 2021; 46:796.e1-796.e3. [PMID: 33541742 DOI: 10.1016/j.ajem.2021.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
Internal hernias are a rare occurrence, reported in only 0.2-0.9% of the general population, and predominantly occur in adult patients as postsurgical complications. However, internal hernias can occur in pediatric patients, typically due to herniation of bowel through congenital mesenteric defects, and are associated with high rates of strangulation or volvulus (up to 30-40%) in this population. These can be especially difficult to detect due to nonspecific symptoms and rarity, but carry a steep mortality rate of 45% if treated and virtually 100% if missed. We present a case report that describes a 3 year old patient who presented to the emergency department with less than 12 h of nonbloody, nonbilious emesis and associated abdominal pain with preserved ability to tolerate oral intake. She ultimately went on to have ultrasound and then CT imaging that revealed a high grade bowel obstruction due to an internal hernia from a mesenteric defect for which she required emergent resection of 119 cm of necrotic bowel. Ultimately this case illustrates a fairly benign presentation of a rare etiology of pediatric vomiting and abdominal pain that if left undetected could prove fatal, and is therefore essential for the emergency clinician to consider on the differential for vomiting and nonspecific abdominal pain in the pediatric patient.
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41
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Vizuete Del Río J, Martín Benítez G, Ripollés González T, Merino Bonilla JA, San-Miguel T. Bowel ultrasonography in acute abdomen: beyond acute appendicitis. RADIOLOGIA 2021; 63:193-205. [PMID: 33551121 DOI: 10.1016/j.rx.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/03/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
Acute abdomen is a common reason for consultation in the emergency department. A broad spectrum of entities, including diverse diseases of the gastrointestinal tract, can cause acute abdomen. Although computed tomography is the technique most widely used to evaluate acute abdomen in the emergency department, abdominal ultrasound is often performed first and allows bowel disease to be suspected. This article describes the ultrasound features of diverse bowel diseases that can cause acute abdomen, such as acute diverticulitis, bowel obstruction, gastrointestinal perforation, bowel ischemia, intraabdominal fat necrosis, and miscellaneous processes such as endometriosis, foreign bodies, or vasculitis. Radiologists must be familiar with the different features of abnormal bowel that can be detected incidentally in patients without clinical suspicion of bowel disease. This article focuses on ultrasonographic signs of bowel disease; other articles in this series cover the ultrasonographic signs of acute appendicitis, inflammatory bowel disease, and infectious diseases.
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Affiliation(s)
- J Vizuete Del Río
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - G Martín Benítez
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - T Ripollés González
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - J A Merino Bonilla
- Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, España.
| | - T San-Miguel
- Departamento de Anatomía Patológica, Facultad de Medicina, Universidad de Valencia, Valencia, España
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Nakaseko Y, Haruki K, Neki K, Hashizume R, Eto K, Yanaga K. Laparoscopy-Assisted Repair for Intersigmoid Hernia. Case Rep Gastroenterol 2020; 14:675-682. [PMID: 33442348 PMCID: PMC7772840 DOI: 10.1159/000509499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 01/18/2023] Open
Abstract
Intersigmoid hernia is a rare clinical entity. Only 6 cases of laparoscopic repair for intersigmoid hernia have been reported since 1977. We herein report such a case, which was successfully diagnosed preoperatively and treated with laparoscopic repair. A 50-year-old man with a chief complaint of abdominal pain and vomiting was admitted for the treatment of small bowel obstruction. The patient had no history of abdominal surgery. Computed tomography showed a dilated small bowel and a closed loop of small bowel dorsal to the sigmoid colon and the sigmoid mesocolon. With a diagnosis of an incarcerated internal hernia, the patient underwent emergency laparoscopy-assisted surgery. Laparoscopy showed that the ileum had herniated into the intersigmoid fossa, and therefore the patient was diagnosed with an intersigmoid hernia. Because bowel ischemia was not observed, we reduced the incarcerated small bowel, and the hernial defect was widely opened. After operation, the patient developed ileus and was treated with transnasal ileus tube. Thereafter, the patient made a satisfactory recovery and was discharged on postoperative day 21. The patient is in good general condition without ileus 42 months postoperatively.
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Affiliation(s)
- Yuichi Nakaseko
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichiro Haruki
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kai Neki
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Hashizume
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Eto
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Yanaga
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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43
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Hakmi H, Hashmi H, Hunt J, Levine J. Laparoscopic repair of incarcerated transverse colon internal hernia in a patient with Crohn's disease. J Surg Case Rep 2020; 2020:rjaa482. [PMID: 33343865 PMCID: PMC7737001 DOI: 10.1093/jscr/rjaa482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 01/13/2023] Open
Abstract
Internal hernia is a rare cause of bowel obstruction in patients with no prior surgical history. Laparoscopic repair of a transverse bowel herniation through the foramen of Winslow is the rarest type of internal hernia, with only two case reports published in the literature. In a patient with a history with Crohn’s disease and no prior surgical history, presenting with signs of bowel obstruction, and no inflammatory symptoms, internal hernia should be suspected as one of the causes. Minimally invasive laparoscopic repair is a feasible safe option in those patients, allowing patients to go home the next day postoperatively.
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Affiliation(s)
- Hazim Hakmi
- NYU Long Island, Department of Surgery, Mineola, NY, USA
| | - Hassan Hashmi
- NYU Long Island, Department of Surgery, Mineola, NY, USA
| | - Jackson Hunt
- NYU Long Island, Department of Surgery, Mineola, NY, USA
| | - Jun Levine
- NYU Long Island, Department of Surgery, Mineola, NY, USA
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44
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Maheshwari S, Khadka A, Bhattacharjee S, Rajesh U, Maria V. A case report of left paraduodenal hernia with a spontaneous reduction on follow-up: the rare demonstration on computed tomography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00338-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Left paraduodenal hernia (PDH) makes for around 40% of all internal hernias. It is due to the prolapse of bowel through fossa of Landzert, an anatomic variant that is found in around 2% of the population. This hernia is presumed to be spontaneously reducible in many patients with recurrent symptoms.
Case presentation
The present report shows the case of this condition in a 65-year-old male presenting with recurrent abdominal pain and subacute intestinal obstruction who was unwilling for surgery and was managed conservatively. A follow-up scan after 11 months revealed complete spontaneous resolution of hernia.
Conclusions
This represents only the second demonstration of the oft-mentioned spontaneous reduction of this condition on computed tomography. The radiologists should be aware of this uncommon entity and in the event of clinical suspicion; the imaging should be performed when the patient is symptomatic.
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45
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Salam DH, Al-Tarakji M, Alaieb AI, Singh R, El-Menyar A, Al-Thani H, Zarour A, Ellabib M. Post-trauma transmesocolic hernia: a case report. J Surg Case Rep 2020; 2020:rjaa417. [PMID: 33123345 PMCID: PMC7575331 DOI: 10.1093/jscr/rjaa417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 12/04/2022] Open
Abstract
The prevalence of transmesocolic hernias, a subtype of internal hernias (IHs), is generally low. Its clinical consequences, including strangulation, ischemia and even death, however, necessitate awareness. IHs are classified as congenital or acquired as resulting from surgery, trauma or intraperitoneal inflammation. This is a case of a 37-year-old male victim of a motor vehicle collision 1 month prior to the index admission. The trauma-related injuries were managed conservatively and then discharged home. The patient was re-admitted with a 2-day history of epigastric pain, vomiting and abdominal distension. A diagnosis of small bowel obstruction due to a transmesocolic hernia was made on CT and emergency laparotomy performed. The post-operative course was unremarkable. It is vital to consider transmesocolic hernias in trauma patients presenting with a picture of bowel obstruction even in the absence of prior surgery.
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Affiliation(s)
- Doaa Hussin Salam
- Department of Surgery, Acute Surgery Care, Hamad General Hospital, Doha, Qatar
| | - Mohannad Al-Tarakji
- Department of Surgery, Acute Surgery Care, Hamad General Hospital, Doha, Qatar
| | | | - Rajvir Singh
- Department of Surgery, Acute Surgery Care, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Department of Surgery, Acute Surgery Care, Hamad General Hospital, Doha, Qatar
| | - Mohamed Ellabib
- Department of Surgery, Acute Surgery Care, Hamad General Hospital, Doha, Qatar
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46
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Buisset C, Postillon A, Aziz S, Bilbault F, Hoch G, Nesseler JP, Johann M. Laparoscopic management of an ascending colon hernia through the foramen of Winslow. J Surg Case Rep 2020; 2020:rjaa283. [PMID: 32922726 PMCID: PMC7476804 DOI: 10.1093/jscr/rjaa283] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 12/28/2022] Open
Abstract
Herniation through the foramen of Winslow is rare, with a non-specific clinical presentation and his diagnosis may be difficult. A 44-year-old female was admitted with an acute epigastric abdominal pain. A computed tomography showed an internal hernia of the colon in the lesser sac. Laparoscopic reduction of the herniated contents and the fixation of the ascending colon with several non-absorbable sutures were performed. Twenty months after surgery, the patient has not experienced any recurrence. Computed tomography helps practitioners to the preoperative diagnosis of herniation through the foramen of Winslow, to the viability of the herniated contents and presence of occlusion. In case of herniation through the foramen of Winslow favored by a mobile ascending colon with a misapposition of the right Told fascia, the fixation of the colon with a non-absorbable suture was safe and may prevent the risk of recurrent internal hernia and colonic volvulus.
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Affiliation(s)
- Cyrille Buisset
- Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman - Hôpitaux Privés de Metz, Metz, France
| | - Agathe Postillon
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Sandrine Aziz
- Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman - Hôpitaux Privés de Metz, Metz, France
| | - Florian Bilbault
- Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman - Hôpitaux Privés de Metz, Metz, France
| | - Guillaume Hoch
- Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman - Hôpitaux Privés de Metz, Metz, France
| | - Jean-Philippe Nesseler
- Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman - Hôpitaux Privés de Metz, Metz, France
| | - Marc Johann
- Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman - Hôpitaux Privés de Metz, Metz, France
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Roux A, David V, Durand Fontanier S, Mathonnet M, Taibi A. Acute intestinal ischaemia due to a foramen of Winslow hernia. Intern Emerg Med 2020; 15:1105-1106. [PMID: 32198721 DOI: 10.1007/s11739-020-02312-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/07/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Alexia Roux
- Digestive Surgery Department, Saint Junien Hospital, Saint Junien, France
| | - Valentin David
- Pharmacy Department, Dupuytren University Hospital, Limoges, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren University Hospital, Limoges, France
- University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Muriel Mathonnet
- Digestive Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Abdelkader Taibi
- Digestive Surgery Department, Saint Junien Hospital, Saint Junien, France.
- Digestive Surgery Department, Dupuytren University Hospital, Limoges, France.
- University Limoges, CNRS, XLIM, UMR 7252, Limoges, France.
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Bautista-Álvarez FE, Pérez-Soto RH, Clemente-Gutiérrez U, Hernández-Villegas AC, Sierra-Salazar M. Foramen of Winslow hernia: A rare cause of acute abdomen. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 85:360-362. [PMID: 31748180 DOI: 10.1016/j.rgmx.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Affiliation(s)
- F E Bautista-Álvarez
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - R H Pérez-Soto
- Servicio de Cirugía Endocrina y Laparoscopia Avanzada, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - U Clemente-Gutiérrez
- Servicio de Cirugía Endocrina y Laparoscopia Avanzada, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A C Hernández-Villegas
- Departamento de Radiología e Imagen «Dr. Adan Pitol Croda», Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - M Sierra-Salazar
- Servicio de Cirugía Endocrina y Laparoscopia Avanzada, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Foramen of Winslow hernia: A rare cause of acute abdomen. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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50
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Intersigmoid Hernia: A Forgotten Diagnosis-A Systematic Review of the Literature over Anatomical, Diagnostic, Surgical, and Medicolegal Aspects. Emerg Med Int 2020; 2020:4891796. [PMID: 32566302 PMCID: PMC7285387 DOI: 10.1155/2020/4891796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/24/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. The purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results The diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1-10 cm, SD 1.15 cm) and the length of the incarcerated small intestine was between 3 cm (min) and 150 cm (max): mean 25.25 cm, SD 35.04 cm. The diameter of the sigmoid recess was greater in patients who underwent resection due to strangulation (mean 3.31 cm, SD 1.53 cm) compared to those who underwent only reduction of the hernia (mean 2.35 cm, SD 0.74 cm). The time from onset to operation was less in patients undergoing resection surgery due to throttling (mean 3.03 days, SD 3.01 days) compared to those who underwent only a reduction of hernia incarceration (mean 8.49 days, SD 6.83 days). Conclusion Intersigmoid hernia is often a forgotten diagnosis and a clinical challange due to its anatomical characteristics.
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