51
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Tatsuta K, Miyazaki S, Nishiwaki Y. Emergency laparoscopic approach without sufficient preoperative decompression for intersigmoid hernia: A case report. Int J Surg Case Rep 2019; 64:54-57. [PMID: 31600670 PMCID: PMC6796653 DOI: 10.1016/j.ijscr.2019.09.036] [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] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
Emergency laparoscopy can be performed without sufficient small bowel decompression. MDCT is advantageous for preoperatively recognizing anatomical relationships. Careful preoperative diagnosis and emergency laparoscopy can lead to good outcomes.
Introduction In acute care surgery, an increasing number of patients operatively treated for small bowel obstruction undergo laparoscopic procedures. However, intersigmoid hernia is a rare condition. In some reports, surgeons have successfully operated on patients with an intersigmoid hernia via a laparoscopic approach. The laparoscopic approach has the advantage of facilitating simultaneous diagnosis and surgical intervention for intersigmoid hernias. In the laparoscopic approach, sufficient decompression of the small bowel is preoperatively performed in most cases. Presentation of case We encountered a patient with an intersigmoid hernia who underwent an emergency laparoscopic approach without sufficient decompression. Because sufficient decompression of the small bowel was not preoperatively performed, it was difficult to establish a working space and visualize the site of obstruction; however, we performed the laparoscopic approach safely, and diagnosis and surgical intervention were possible. Moreover, the postoperative course was uneventful. Discussion We successfully performed an emergency surgery using a laparoscopic approach for an intersigmoid hernia without sufficient decompression. The success of the procedure is attributable to the disease-specific surgical strategy, surgical technique, and the recent technological advances in multidetector-row computed tomography. Conclusion We believe that careful preoperative diagnosis and strategy can lead to a good outcome and that the significance of emergency laparoscopic approach without sufficient decompression will keep increasing.
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Affiliation(s)
- Kyota Tatsuta
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
| | - Shinichiro Miyazaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
| | - Yoshiro Nishiwaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
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52
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Treitz Hernia: Report of a Case and Review of the Literature. Surg Laparosc Endosc Percutan Tech 2019; 29:e102-e107. [PMID: 31385923 DOI: 10.1097/sle.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Congenital hernias are rare findings, and their diagnosis is often delayed due to an incorrect interpretation of the clinical symptoms and/or images. We present a rare case of left-sided paraduodenal hernia at the ligament of Treitz, followed by a review of the literature. CASE PRESENTATION We report the case of a 20-year-old patient with unusual, recurring abdominal pain in the past 3 months. There were no previous operations or past illnesses in the patient's history. The computed tomographic scan showed a misplacement of small bowel into the lesser sack. With high suspicion of an internal hernia, we performed a diagnostic laparoscopy, which revealed a Treitz hernia. The reduction and fixation could be carried out fully with minimally invasive surgery with an uneventful postoperative course and complete recovery. CONCLUSION A Treitz hernia is a rare cause of unspecific abdominal pain and the clinical signs are difficult to interpret. However, its knowledge may help to avoid emergency procedures and provide quick recovery of the patients. We recommend the laparoscopic approach as the first choice of treatment in all cases of internal hernia in the absence of peritoneal irritation or severe bowel obstruction.
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53
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Sim KK, Foster A. Herniation of the hepatic flexure through the foramen of Winslow, and a review of literature describing the minimally invasive technique. BMJ Case Rep 2019; 12:12/7/e230166. [PMID: 31300604 DOI: 10.1136/bcr-2019-230166] [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: 11/04/2022] Open
Abstract
Foramen of Winslow hernias is a rare and challenging diagnosis as signs and symptoms are usually non-specific. CT imaging has become the method of choice in diagnosing such conditions preoperatively. Traditionally managed via laparotomy, there has been an increase in the use of the minimally invasive technique in recent times, though experience remains sparse. This is a case of a 73-year-old woman with hepatic flexure herniation through the foramen of Winslow who was managed by the traditional laparotomy approach. A review of the literature was performed to learn key techniques in the use of laparoscopy to manage future cases.
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Affiliation(s)
- Kwang Kiat Sim
- General Surgery, South Metropolitan Health Service and East Metropolitan Health Service Library and Information Service Royal Perth Hospital, Murdoch, Western Australia, Australia
| | - Amanda Foster
- Acute Surgical Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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54
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AlJaberi LM, Salameh AK, Mashalah RM, AbuMaria A. Pericecal hernia in a pediatric patient: Case report and literature review. Int J Surg Case Rep 2019; 60:296-298. [PMID: 31269468 PMCID: PMC6609735 DOI: 10.1016/j.ijscr.2019.06.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/24/2019] [Accepted: 06/21/2019] [Indexed: 12/15/2022] Open
Abstract
Pericecal hernia is a rare type of internal hernias accounting for 0.1–6.6% of all internal hernias. Pericecal hernia is rare in pediatric patients, clinical presentation depends on the degree of bowel obstruction. Keeping in mind the radiation risks. CT scan is the key for internal hernia diagnosis and management. High index of clinical suspicion and early intervention saves the patient from extensive bowel resection.
Introduction Pericecal hernia is a rare cause of small bowel obstruction. They tend to affect the adult population more commonly but also may occur in the pediatric age group. Case presentation We herein present a 16-year-old male who presented with 4 days of abdominal pain and distention. CT scan revealed evidence of dilated small bowel loops with evidence of ischemia. A laparotomy was performed and revealed a 20 cm segment of distal ileum protruding through the superior ileocecal recess. Ileocecectomy with primary side to side anastomosis was successfully performed and the patient recovered uneventfully after the procedure. Discussion Although internal hernias may have a congenital etiology, most of the reported cases have occurred during adulthood and its presentation in childhood is uncommon. CT scan is the key for internal hernia diagnosis and management as it provides information about the presence of bowel obstruction, strangulation, and ischemia. Conclusion High index of clinical suspicion and early intervention saves the patient from extensive bowel resection and other serious complications.
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Affiliation(s)
- Loay M AlJaberi
- Bethlehem Arab Society for Surgery and Rehabilitation, Bethlehem, Palestine(1).
| | - AlaaEddin K Salameh
- Bethlehem Arab Society for Surgery and Rehabilitation, Bethlehem, Palestine(1)
| | - Raed M Mashalah
- Bethlehem Arab Society for Surgery and Rehabilitation, Bethlehem, Palestine(1)
| | - Ayman AbuMaria
- Bethlehem Arab Society for Surgery and Rehabilitation, Bethlehem, Palestine(1)
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55
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Miyoshi Y, Hirano Y, Kondo Y, Note H, Takagi M, Takizawa S, Okamoto K, Tanaka H. Diagnostic feature of imaging for hernia through the foramen of Winslow. Acute Med Surg 2019; 6:423-424. [PMID: 31592326 PMCID: PMC6773623 DOI: 10.1002/ams2.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Yukari Miyoshi
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan
| | - Yohei Hirano
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan
| | - Hiromasa Note
- Department of Gastrointestinal Surgery Funabasi Municipal Medical Center Chiba Japan
| | - Masao Takagi
- Department of General Medicine Juntendo University Bunkyo-ku Japan
| | - Satoshi Takizawa
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan
| | - Ken Okamoto
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan
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56
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Lanzetta MM, Masserelli A, Addeo G, Cozzi D, Maggialetti N, Danti G, Bartolini L, Pradella S, Giovagnoni A, Miele V. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:20-37. [PMID: 31085971 PMCID: PMC6625567 DOI: 10.23750/abm.v90i5-s.8344] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Indexed: 12/16/2022]
Abstract
Although internal hernias are uncommon, they must be beared in mind in the differential diagnosis in cases of intestinal obstruction, especially in patients with no history of previous surgery or trauma. Because of the high possibility of strangulation and ischemia of the affected loops, internal hernias represent a potentially life-threatening condition and surgical emergency that needs to be quickly recognized and managed promptly. Imaging plays a leading role in the diagnosis and in particular multidetector computed tomography (MDCT), with its thin-section and high-resolution multiplanar reformatted (MPR) images, represents the first line image technique in these patients. The purpose of the present paper is to illustrate the characteristic anatomic location, the clinical findings and the CT appearance associated with main types of internal hernia, including paraduodenal, foramen of Winslow, pericecal, sigmoid-mesocolon- and trans-mesenteric-related, transomental, supravesical and pelvic hernias. (www.actabiomedica.it)
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57
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Schizas D, Apostolou K, Krivan S, Kanavidis P, Katsaros I, Vailas M, Koutelidakis I, Chatzimavroudis G, Pikoulis E. Paraduodenal hernias: a systematic review of the literature. Hernia 2019; 23:1187-1197. [PMID: 31006063 DOI: 10.1007/s10029-019-01947-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. METHODS After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. CONCLUSIONS PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.
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Affiliation(s)
- D Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - K Apostolou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece.
| | - S Krivan
- Department of Upper Gastrointestinal and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, UK
| | - P Kanavidis
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Katsaros
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - M Vailas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Koutelidakis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - G Chatzimavroudis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - E Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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58
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El-Kheir A, Sleiman Y, Hamdach O, Ismail L, Allouch M. Broad-Ligament Hernia: A Rare Cause of Small Bowel Obstruction. Am Surg 2019. [DOI: 10.1177/000313481908500409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alaa El-Kheir
- Department of General Surgery Nini Hospital Lebanese University Tripoli, Lebanon
| | - Youssef Sleiman
- Department of General Surgery Nini Hospital Lebanese University Tripoli, Lebanon
| | - Omar Hamdach
- Department of General Surgery Nini Hospital Lebanese University Tripoli, Lebanon
| | - Layla Ismail
- Department of Diagnostic Radiology Nini Hospital Beirut Arab University Beirut, Lebanon
| | - Mustafa Allouch
- Department of General Surgery Nini Hospital Lebanese University Tripoli, Lebanon
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59
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Al-Omari MA, Al-Doud MA. Simultaneous small and large bowel obstruction as a consequence of internal hernia: A case report. Int J Surg Case Rep 2019; 57:28-32. [PMID: 30877990 PMCID: PMC6423352 DOI: 10.1016/j.ijscr.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022] Open
Abstract
There are no cardinal symptoms for internal hernia. Internal hernia must be kept as a differential diagnosis in the case of intestinal obstruction in both operated and non-operated abdomen. Early diagnosis both clinically and radiologically may prevent undesirable complications. Both patient status and surgeon's experience are essential to form the best surgical decision. Fine handling of bowel, assessment of viability, closure of defects and inspecting for other potential ones, and argumenting stoma formation are the main principles of surgery.
Introduction Intestinal obstruction ascribed to internal hernia is quite rare, especially in adults. There are no differentiating features in the presentation of intestinal obstruction due to internal hernia as compared to other causes. Delay in the diagnosis of this condition carries a considerable risk especially in a virgin abdomen. We report a rare case of internal hernia which presented as acute small and large bowel obstruction. Presented case We report a 47- year- old male with generalized abdominal pain associated with vomiting and obstipation. The patient was in hypovolemic shock that only had a transient response to resuscitation. CT scans of the abdomen with contrast was done and showed both large and small bowel obstruction. Exploration laparotomy was done and revealed a concurrent nonviable portion of ileum and twisted sigmoid colon (volvulus) which protruded through a congenital transmesentric defect. Resection was mandatory, and repair of the defect was done. Discussion Incidence of internal hernia generally does not exceed 1%. The diagnosis of congenital internal hernia relies on absence history of trauma, inflammatory process and abdominal surgery. Protrusion of simultaneous small and large bowels together through transmesenteric congenital gate is uncommon. Conclusion Whether the patient presenting with intestinal obstruction has a history of undergoing previous surgeries (for any reason) or not, the diagnosis of internal hernia must be kept in mind. Coexisting involvement of both small and large bowels that need resection poses the question of the need for restoration of bowel continuity with either colostomy or ileostomy.
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Affiliation(s)
- Malek A Al-Omari
- Department of General Surgery, Jordanian Royal Medical Services (JRMS), Amman, Jordan.
| | - Mohammad A Al-Doud
- Department of General Surgery, Jordanian Royal Medical Services (JRMS), Amman, Jordan.
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60
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Kulkarni GV, Premchandani D, Chitnis A, Katara A, Bhandarkar DS. Laparoscopic repair of a combined transmesocolic, transomental hernia. J Minim Access Surg 2019; 16:83-86. [PMID: 30777991 PMCID: PMC6945348 DOI: 10.4103/jmas.jmas_244_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transmesocolic and transomental hernias (TOHs) are rare types of internal hernia. Both these hernias occurring concurrently in a patient are even rarer. We report a patient with signs of recurrent small-bowel obstruction who was found to have a dual transmesocolic, TOH. Computed tomography imaging and subsequent laparoscopic exploration identified small-bowel loops passing through a defect in the transverse mesocolon behind the stomach to emerge through the gastrohepatic omentum. This was treated successfully by laparoscopy. To the best of our knowledge, this is the first reported case of a combined transmesocolic, TOH undergoing successful laparoscopic repair.
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Affiliation(s)
- Gaurav V Kulkarni
- Department of General Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Dhiraj Premchandani
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Akshay Chitnis
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Avinash Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Deepraj S Bhandarkar
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
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61
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Forsythe CM, Sanchirico PJ, Pfeiffer DC. Internal hernia with incarceration of the cecum through a loop created by an elongated fallopian tube. Radiol Case Rep 2019; 14:282-286. [PMID: 30559919 PMCID: PMC6288712 DOI: 10.1016/j.radcr.2018.11.010] [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] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/20/2022] Open
Abstract
We describe a case of a 61-year-old female who presented to the emergency department with a 2-week history of severe right and left lower abdominal quadrant abdominal pain that radiated to the back and was accompanied by nausea and vomiting. An initial computed tomography scan with contrast demonstrated unusual loops of small bowel in the left paracentral pelvis. Follow-up computed tomography scans revealed worsening dilation of the cecum. Exploratory laparotomy was indicated and revealed a mobile right mesenteric stalk, which had migrated to the left lower abdominal quadrant and become incarcerated within a loop formed by a 25 cm long left fallopian tube. The distal end of the fallopian tube was firmly adherent to the parietal peritoneum of the left lower quadrant. A right hemicolectomy and a left salpingo-oophorectomy were performed. This case appears to be the first to document the internal herniation of a mobile cecum and right mesenteric stalk through a highly unusual loop created by an elongated left fallopian tube.
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Affiliation(s)
- Charlie M. Forsythe
- WWAMI Medical Education Program (MD), University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | | | - David C. Pfeiffer
- WWAMI Medical Education Program and Department of Biological Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-3051, USA
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62
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Hasnaoui H, Mouaqit O, Benjelloun EB, Ousadden A, Taleb KA, Bouhaddouti HE. [Internal hernia through the falciform ligament: a rare cause of intestinal obstruction]. Pan Afr Med J 2019; 32:48. [PMID: 31143353 PMCID: PMC6522209 DOI: 10.11604/pamj.2019.32.48.17845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/09/2019] [Indexed: 11/11/2022] Open
Abstract
Internal hernias are a rare cause of acute intestinal obstruction. Hernias through the falciform ligament is uncommon. Diagnosis is often made intraoperatively. Abdominal CT scan, performed in an emergency situation, can enable preoperative diagnosis and guide the therapeutic approach. In this respect, we here report a case whose data were collected in the Department of Visceral Surgery at the University Hospital Hassan II in Fez. The study involved a 48-year old patient, with no particular previous history, admitted to the Emergency Department with occlusion evolving over 4 days. Abdominal x-ray without treatment objectified multiple hydroaeric levels in small bowel some of which projected towards the hepatic region as well as the presence of a flat intestinal loop in continuity with distended intestinal segment. Abdominal CT scan was not performed due to altered renal function. The patient then underwent emergency surgery after stabilization of his condition and the diagnosis of internal hernias through the falciform ligament was made intraoperatively. In adults, internal hernia through the falciform ligament is a rare cause of acute intestinal obstruction in our daily practice. The diagnosis is most often made intraoperatively. It is necessary to suspect it in young patients with no history of abdominal surgery or intraperitoneal infectious process and with hydroaeric levels in the right upper quadrant.
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Affiliation(s)
- Hamza Hasnaoui
- Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.,Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah de Fès, Maroc
| | - Ouadii Mouaqit
- Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.,Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah de Fès, Maroc
| | - El Bachir Benjelloun
- Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.,Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah de Fès, Maroc
| | - Abdelmalek Ousadden
- Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.,Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah de Fès, Maroc
| | - Khalid Ait Taleb
- Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.,Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah de Fès, Maroc
| | - Hicham El Bouhaddouti
- Service de Chirurgie Viscérale A, CHU Hassan II, Fès, Maroc.,Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah de Fès, Maroc
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63
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Guan J, Watrelot A. Fallopian tube subtle pathology. Best Pract Res Clin Obstet Gynaecol 2019; 59:25-40. [PMID: 31227442 DOI: 10.1016/j.bpobgyn.2018.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 12/25/2022]
Abstract
The aim of the present review is to give a comprehensive overview of fallopian subtle lesions and suggest the impacts of these abnormalities on fertility. Tubal subtle variations, including tubal diverticula, Morgagni hydatids, accessory fallopian tube, accessory ostium of the fallopian tube, tubal phimosis, agglutination, and sacculation, have been described and cited as making significant contributions to infertility. This review summarizes characteristics of these subtle abnormalities and provides an update of recent knowledge of the diagnosis and management of these variations. We hope that the present contribution may help to bring more attention to the clinical field to recognize these abnormalities and consequently aid in improving fertility.
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Affiliation(s)
- Jing Guan
- Reproductive Medicine Center, Peking University People's Hospital, Beijing, China.
| | - Antoine Watrelot
- Centre de Recherche et d'Etude de la Stérilité (CRES), Lyon, France.
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64
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Pires ACA, Oliveira DC, Nacif MS, Martin MF, Indiani JMC. Broesike hernia: long-standing incharacteristic abdominal pain. Radiol Bras 2018; 51:338-339. [PMID: 30369666 PMCID: PMC6198849 DOI: 10.1590/0100-3984.2017.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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65
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Xiang H, Han J, Ridley WE, Ridley LJ. Beaking of bowel: Bowel obstruction. J Med Imaging Radiat Oncol 2018; 62 Suppl 1:55. [PMID: 30309079 DOI: 10.1111/1754-9485.03_12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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66
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Deschner BW, Schwulst SJ. Spontaneous reduction of acute cecal herniation through the foramen of Winslow. J Surg Case Rep 2018; 2018:rjy236. [PMID: 30214711 PMCID: PMC6130223 DOI: 10.1093/jscr/rjy236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022] Open
Abstract
This is the case of a 70-year-old woman who presented to the emergency department complaining of 2 hours of acute-onset epigastric pain. She had experienced this pain once before which had spontaneously resolved. Axial imaging demonstrated the cecum in an abnormal position within the lesser sac, as well as compression of the inferior vena cava and portal vein. She was taken emergently to the operating room for laparotomy, where a free-floating cecum and ascending colon was identified without ischemia, and a right hemicolectomy was performed. Foramen of Winslow hernias are rare internal hernias with a high rate of strangulation and bowel ischemia, requiring urgent surgical intervention. Operative treatment depends on the type of herniated viscera. Spontaneous reduction is not well documented.
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Affiliation(s)
- Benjamin W Deschner
- Division of Trauma and Critical Care, Department of Surgery, Northwestern University, 676 N. St. Clair St., Ste #650, Chicago, IL 60611, USA
| | - Steven J Schwulst
- Division of Trauma and Critical Care, Department of Surgery, Northwestern University, 676 N. St. Clair St., Ste #650, Chicago, IL 60611, USA
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67
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Welaratne I, Nasoodi A. A Rare Cause of Obstructive Jaundice: Cecal Herniation through the Foramen of Winslow. J Clin Imaging Sci 2018; 8:24. [PMID: 30034928 PMCID: PMC6029008 DOI: 10.4103/jcis.jcis_12_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/12/2018] [Indexed: 01/05/2023] Open
Abstract
Internal abdominal hernias are rarely reported in the literature and have a very low rate of preoperative diagnosis. It is even rarer that they present with jaundice. A 59-year-old Caucasian female presented with a short history of jaundice, dark urine, epigastric pain, vomiting, and obstipation. Her liver biochemistry profile revealed a mixed cholestatic/hepatocellular pattern with significantly elevated bilirubin. She urgently underwent abdominal imaging which provided a preoperative diagnosis of internal herniation of the cecum within the lesser sac through the foramen of Winslow. The dilated bowel was compressing the common bile duct explaining the jaundice. This was repaired intraoperatively by anchoring the mobile cecum. In this case, we highlight the importance of maintaining a high index of suspicion for internal herniation on abdominal imaging with clinical evidence of intestinal obstruction. A foramen of Winslow hernia should be further suspected in the presence of jaundice.
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Affiliation(s)
- Ivan Welaratne
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - Afshin Nasoodi
- Department of Radiology, St James's Hospital, Dublin, Ireland
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68
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Manipadam JM, V L, Syamprasad V, H R. Laparoscopic Repair of a Right Paraduodenal Hernia. Surg J (N Y) 2018; 4:e129-e132. [PMID: 30038962 PMCID: PMC6054577 DOI: 10.1055/s-0038-1667149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/14/2018] [Indexed: 12/26/2022] Open
Abstract
Laparoscopic repair of a right paraduodenal hernia has been described sparingly in literature. We present an account of how we laparoscopically repaired a right paraduodenal hernia along with a review of the current literature as regards the various techniques that have been attempted. With the patient in supine position, and with umbilical camera port and three 5 mm ports, we mobilized the cecum and ascending colon up to the third part of the duodenum, thereby widening the neck of the hernia sac in the Waldeyer fossa. This method is ideal for the less severe incomplete rotation presenting with right paraduodenal hernia where there are no Ladd's bands and there is no requirement for fetalization of the bowel.
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Affiliation(s)
- John Mathew Manipadam
- Department of GI Surgery, VPS Lakeshore Hospital and Research Centre, Kochi, Kerala, India
| | - Lekha V
- Department of GI Surgery, VPS Lakeshore Hospital and Research Centre, Kochi, Kerala, India
| | - Vamsi Syamprasad
- Department of GI Surgery, VPS Lakeshore Hospital and Research Centre, Kochi, Kerala, India
| | - Ramesh H
- Department of GI Surgery and Liver Transplantation, VPS Lakeshore Hospital and Research Centre, Kochi, Kerala, India
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69
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Turenkov A, Kelley KM, Boustany M. Internal Hernia as Cause of Small Bowel Obstruction without History of Gastrointestinal Surgery. Am Surg 2018. [DOI: 10.1177/000313481808400709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Marc Boustany
- Department of Surgery Eastern Virginia Medical School Norfolk, Virginia
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70
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Shadhu K, Ramlagun D, Ping X. Para-duodenal hernia: a report of five cases and review of literature. BMC Surg 2018; 18:32. [PMID: 29848337 PMCID: PMC5977483 DOI: 10.1186/s12893-018-0365-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/22/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Para-duodenal hernia (PDH) represents rare clinical entities based on few literatures. CASE PRESENTATION We report five cases of Para-duodenal hernia, all occurring in male patients ranging from 34 to 75 years of age. The patients had varied manifestations presenting with abdominal pain with or without vomiting and nausea and with or without signs of intestinal obstruction. CT images showed cluster of dilated bowel segments with displaced mesenteric vessels at hernial orifice. Laparoscopic surgical approach was adopted, and the patients were discharged about a week later without further complications. CONCLUSION We hope to raise awareness about the management of this rare clinical entity and the benefits of CT imaging and laparoscopic surgery as standard approaches.
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Affiliation(s)
- Kamleshsingh Shadhu
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, 210029 Jiangsu Province People’s Republic of China
- Pancreas Center, Jiangsu Province Hospital, First Affiliated hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, 210029 Jiangsu Province People’s Republic of China
| | - Dadhija Ramlagun
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, 210029 Jiangsu Province People’s Republic of China
- Department of Breast Surgery, Jiangsu Province Hospital, First Affiliated hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, 210029 Jiangsu Province People’s Republic of China
| | - Xiaochun Ping
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, 210029 Jiangsu Province People’s Republic of China
- Department of Gastric Surgery, Jiangsu Province Hospital, First Affiliated hospital of Nanjing Medical University, Guangzhou Road, 300, Gulou District, Nanjing, 210029 Jiangsu Province People’s Republic of China
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Haddad A, Sebai A, Rhaiem R, Ghedira A, Daghfous A. A strangled hernia through the Winslow's hiatus: about a rare situation. Ann R Coll Surg Engl 2018; 100:e123-e124. [PMID: 29607725 PMCID: PMC5956603 DOI: 10.1308/rcsann.2018.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 11/22/2022] Open
Abstract
Winslow's hiatus hernia is the rarest of the internal hernias. Its diagnosis is difficult and requires an urgent laparotomy to avoid necrosis of the incarcerated loop or even the death of the patient. We report the case of a patient operated urgently for acute intestinal obstruction caused by a strangled hernia through the Winslow's hiatus. A reduction by traction of the hernia was undertaken. Rapid management of this pathology is important using clinical and radiographical elements.
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Affiliation(s)
- A Haddad
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - A Sebai
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - R Rhaiem
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - A Ghedira
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - A Daghfous
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
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72
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Shek K, Ditkofsky N, Ashamalla S, Patel C. A case report of caecal herniation through the foramen of Winslow. Ann R Coll Surg Engl 2018; 100:e142-e144. [PMID: 29658335 DOI: 10.1308/rcsann.2018.0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Caecal herniation through the foramen of Winslow is a rare entity of which radiologist should be aware. We present a case of this entity in a patient presenting with diabetic ketoacidosis and ongoing epigastric pain. Abdominal computed tomography demonstrated herniation of the caecum into the lesser sac via the foramen of Winslow. Despite the caecum appearing viable at the time of surgery, the surgeons performed a right hemicolectomy via laparotomy to prevent future recurrence.
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Affiliation(s)
- K Shek
- University of Manitoba College of Medicine , Winnipeg, Manitoba , Canada
| | - N Ditkofsky
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario , Canada
| | - S Ashamalla
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario , Canada
| | - C Patel
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario , Canada
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Farukhi MA, Mattingly MS, Clapp B, Tyroch AH. CT Scan Reliability in Detecting Internal Hernia after Gastric Bypass. JSLS 2017; 21:JSLS.2017.00054. [PMID: 29279662 PMCID: PMC5740779 DOI: 10.4293/jsls.2017.00054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Internal hernia (IH) after gastric bypass can be a life-threatening complication. Obstruction presents acutely or as chronic relapses, with symptoms of abdominal pain, nausea, and vomiting. Early detection and exploration of IH as the cause of small bowel obstruction (SBO) is critical in this surgical emergency and can reduce morbidity and mortality. We conducted a retrospective review of laparoscopic Roux-en-Y bypass (LRYGB) records to determine the specificity and sensitivity of computed tomography (CT) in identifying postoperative IH. Methods: Records of 550 patients who underwent antecolic antegastric laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery over a 5-year period (2010–2014) were retrospectively reviewed for complications. Our study population comprised patients who returned with signs and symptoms of obstruction who underwent CT imaging followed by laparoscopic exploration. Results: Thirty-four patients were found to have obstruction on CT scan at ≥6 weeks after LRYGB. Six (17.7%) were found to have IH by preoperative CT imaging before laparoscopic exploration. Of the 6 patients identified to have IH before exploration, 4 (28%) had consistent findings at operation, yielding a sensitivity of 28.6% and specificity of 90.0%. Operative findings identified other causes of SBO: adhesions (n = 17), IH (n = 14), jejunojejunostomy stenosis (n = 2), and phytobezoar (n = 1). Conclusions: IH after LRYGB is difficult to detect. Our study found CT to have a low sensitivity but a high specificity in detecting IH. Therefore, laparoscopic exploration continues to be the best diagnostic and therapeutic intervention for this complication.
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Affiliation(s)
| | - Michael S Mattingly
- Medical Education, Texas Tech University Health Sciences Center, El Paso, Texas, USA
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Wong YJ, Lath N, Eng AKH, Navasivayam V. Clinical features of paraduodenal hernia. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817744799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Paraduodenal hernia (PDH), though uncommon, is a surgical emergency associated with high risk of strangulation and incarceration. Diagnosis of PDH remains challenging due to its non-specific presentation. We report the presentation and management of PDH in our hospital. All PDHs diagnosed from 2003 to 2014 were identified from a hospital database. Diagnosis of PDH was based on either radiological imaging or intraoperative surgical findings. Eight PDHs were identified during the study period. Median age was 48.5 (24–63) years and five occurred in females. All were left-sided PDHs. Six patients experienced recurrent symptoms prior to presentation. The commonest presenting symptoms were recurrent abdominal pain (four patients) and intestinal obstruction (four patients). Five patients were treated conservatively either because they had no obstructive symptoms or they declined surgery. All of them remained well up to a median of 27 (16–45) months’ follow-up. In contrast, three patients with obstructive symptoms underwent surgical repair (laparotomy, hernia repair and adhesiolysis). One patient had sub-acute intestinal obstruction after surgical repair and required re-exploratory surgery. All three PDH patients with obstructive symptoms remained well on follow-up (median 61 (range: 27–114) months) after surgery. In conclusion, PDH is an uncommon cause of intestinal obstruction. A high index of suspicion is required to diagnose PDH.
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Affiliation(s)
- Yu Jun Wong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Narayan Lath
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Alvin Kim Hock Eng
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore
| | - Vikneswaran Navasivayam
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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Yamashita W, Nishida K, Kawada S, Mori K, Usui S, Oyama J, Toriihara A, Tateishi U. Hooking intestine sign: a typical diagnostic CT finding of Petersen's hernia. Jpn J Radiol 2017; 35:718-723. [PMID: 29039111 DOI: 10.1007/s11604-017-0691-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/29/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To clarify typical diagnostic computed tomography (CT) findings of Petersen's hernia for differentiation from other causes of internal hernia observed in patients having undergone gastrectomy with Roux-en-Y gastric bypass. METHODS We retrospectively reviewed CT findings of internal hernia in patients who had undergone both gastrectomy and Roux-en-Y reconstruction and a second surgery for bowel obstruction. Thirteen patients with Petersen's hernia and 6 with internal hernia other than Petersen's hernia were investigated. Six CT findings, viz. whirl sign, mesenteric fat haziness, intestinal distension in the upper abdomen, herniated intestinal loop above the gastric level, middle/distal ileum courses downwards from the left hypochondrium, and hooking intestine sign, which means two or more intestines pass through the inner side of J-shaped vessels consisting of mesenteric vessels of the elevated jejunum, were scored and evaluated regarding their diagnostic performance. RESULTS The hooking intestine sign showed the highest sensitivity, specificity and accuracy (100%, 100% and 100%). We could detect J-shaped vessels in all Petersen's hernia patients. Inside the J-shaped vessels there were two or more intestinal tracts passing through in the Petersen's hernia group. There was only transverse colon inside the J-shaped vessels in the control group. CONCLUSION The hooking intestine sign may be useful for diagnosing Petersen's hernia on CT.
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Affiliation(s)
- Wataru Yamashita
- Department of Radiology, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, Japan
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate school of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Kenji Nishida
- Department of Radiology, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, Japan
| | - Shuichi Kawada
- Department of Radiology, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, Japan
| | - Kouichi Mori
- Department of Radiology, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, Japan
| | - Shinsuke Usui
- Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, Japan
| | - Jun Oyama
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate school of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Akira Toriihara
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate school of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate school of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.
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Ichikawa Y, Kanazawa A, Dan N, Ishikawa S, Hagi T, Mizojiri G, Tsubakimoto M, Oka H. Case of ileal herniation through the foramen of Winslow diagnosed preoperatively by CT and treated with laparoscopic surgery. Asian J Endosc Surg 2017. [PMID: 28639434 DOI: 10.1111/ases.12372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A previously healthy 35-year-old man visited the emergency room complaining of epigastric pain and vomiting. The pain was sudden in onset. His blood tests were within normal limits except for a mild neutrophilia of 14 300/μL. Enhanced abdominal CT scan showed the small intestine dilated into the space between the portal vein and inferior vena cava from the foramen of Winslow. Under the diagnosis of herniation through the foramen of Winslow (HFW), we performed emergency laparoscopic surgery. Laparoscopy revealed an internal herniation of the dilated small intestine through the foramen of Winslow. Because the herniated small intestine was viable, intestinal resection was unnecessary. We released the incarceration under laparoscopy. HFW is very rare and often overlooked, but abdominal CT examination enabled a precise preoperative diagnosis because of characteristic findings. We should consider the possibility of HFW in patients with internal herniation of unknown origin. Laparoscopic surgery for HFW is effective.
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Affiliation(s)
| | - Akifumi Kanazawa
- Department of Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Nobuhiro Dan
- Department of Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Satoshi Ishikawa
- Department of Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Takaomi Hagi
- Department of Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Gaku Mizojiri
- Department of Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Mituo Tsubakimoto
- Department of Radiology, Moriguchi Keijinkai Hospital, Moriguchi, Japan
| | - Hiroshi Oka
- Department of Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Japan
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Retrocecal hernia preoperatively diagnosed by computed tomography: A case report. Int J Surg Case Rep 2017; 37:186-188. [PMID: 28700968 PMCID: PMC5508610 DOI: 10.1016/j.ijscr.2017.06.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/09/2017] [Accepted: 06/11/2017] [Indexed: 12/03/2022] Open
Abstract
A retrocecal hernia is a rare type of pericecal hernia. The genesis of retrocecal hernias is explained based on the minimal error in rotation with incarceration behind the cecum. Abdominal computed tomography scan is useful for preoperative diagnosis of retrocecal hernia.
Introduction Retrocecal hernia is a rare type of pericecal hernia. Because it is difficult to diagnose preoperatively, it is often treated with emergency operation. Case presentation An 83-year-old male patient experienced sudden abdominal pain. Marked small bowel dilatation and intestinal obstruction were detected by abdominal computed tomography (CT). An enhanced CT scan also revealed a trapped cluster of small bowel loops behind the cecum and ascending colon. We preoperatively diagnosed small bowel ileus as a result of retrocecal hernia. After conservative therapy with a long intestinal tube, an emergency operation was performed. During the surgery, a portion of the ileum was found to be incarcerated in the retrocecal fossa. Intestinal resection was not necessary because the incarcerated ileum appeared viable, and the orifice to the hernia was opened. The patient was discharged without postoperative complications. Discussion The diagnosis of retrocecal hernia can often be confirmed intraoperatively. This disease is identified based on a minimal error in rotation with incarceration behind the cecum during the final phase of descent and fixation of the right colon or failure of cecal and retroperitoneal fixation. Early preoperative diagnosis is important to prevent intestinal ischemia, necrosis, and perforation and to reduce resection rates. Conclusion Early preoperative diagnosis is important to avoid resection of the small intestine. CT scans are useful for preoperative diagnosis in case of retrocecal hernia.
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Zenitani M, Sasaki T, Tanaka N, Oue T. Strangulated right paraduodenal hernia successfully treated with single-incision transumbilical surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Brandão PN, Martins V, Silva C, Davide J. Sigmoid Volvulus Through a Transmesenteric Hernia. J Gastrointest Surg 2017; 21:1102-1103. [PMID: 27826940 DOI: 10.1007/s11605-016-3318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 10/26/2016] [Indexed: 01/31/2023]
Abstract
Internal hernias are a rare pathology with very low incidence. Transmesenteric hernias represent less than 10% of all cases and may occur at any age. They involve more often the small bowel and, more rarely, the colon. We present a case of a sigmoid volvulus through a transmesenteric hernia in a 19-year-old patient.
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Affiliation(s)
- Pedro Nuno Brandão
- General Surgery, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Vilma Martins
- General Surgery, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Cristina Silva
- General Surgery, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - José Davide
- General Surgery, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
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Abdominal Hernias, Giant Colon Diverticulum, GIST, Intestinal Pneumatosis, Colon Ischemia, Cold Intussusception, Gallstone Ileus, and Foreign Bodies: Our Experience and Literature Review of Incidental Gastrointestinal MDCT Findings. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28638830 PMCID: PMC5468579 DOI: 10.1155/2017/5716835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Incidental gastrointestinal findings are commonly detected on MDCT exams performed for various medical indications. This review describes the radiological MDCT spectrum of appearances already present in the past literature and in today's experience of several gastrointestinal acute conditions such as abdominal hernia, giant colon diverticulum, GIST, intestinal pneumatosis, colon ischemia, cold intussusception, gallstone ileus, and foreign bodies which can require medical and surgical intervention or clinical follow-up. The clinical presentation of this illness is frequently nonspecific: abdominal pain, distension, nausea, fever, rectal bleeding, vomiting, constipation, or a palpable mass, depending on the disease. A proper differential diagnosis is essential in the assessment of treatment and in this case MDCT exam plays a central rule. We wish that this article will familiarize the radiologist in the diagnosis of this kind of incidental MDCT findings for better orientation of the therapy.
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Sall I, Diémé E, Diallo M, Bénadji E, Diouf M, Ndiaye B, Fall O, Sow A, Diakhaté IC, Ogougbémy M. The "pouch" of the Douglas's pouch. Morphologie 2017; 101:105-109. [PMID: 28528186 DOI: 10.1016/j.morpho.2017.04.002] [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: 09/10/2015] [Revised: 06/21/2016] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
Hernia is described as the protrusion of an organ into the wall of its normal containing cavity. Internal hernia (IH) involves protrusion of viscera through: a peritoneal or mesentery defect, a normal or abnormal compartment of the peritoneal cavity. Hernias occurring in the pelvis cavity are usually classified according to the fascial margins breached and include sciatic, obturator and those through the rectouterin pouch: elytrocele and enterocele. Those hernias are defined by the protrusion of a viscus through the wall of the pelvis due to weakness of the pelvic fascia and/or muscles. Pelvic hernia through the pouch of Douglas (PD) involves the genital tract in female (elytrocele and enterocele). Sometimes described in the literature as Douglas hernia, this type of hernia must be distinguished from the conventional IH. As defined before, the borders to be considered for IH is the peritoneal membrane, which is not a real solid wall but delimitates the peritoneal cavity; and there is no peritoneal defect in elytrocele or enterocele. A PubMed search for IH through a defect in the peritoneal PD revealed only five female cases, making this an extremely rare condition. To our knowledge, we have presented here the only published case in a male. This probably congenital and morphologic anomaly (defect) of pouch of Sir Douglas must be distinguished as the real "Douglas IH". Authors discuss the concept of a new and more detailed classification of IH.
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Affiliation(s)
- I Sall
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal.
| | - E Diémé
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal
| | - M Diallo
- Department of radiology, hôpital principal de Dakar, hôpital d'instruction des Armées, Dakar, Senegal
| | - E Bénadji
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal
| | - M Diouf
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal
| | - B Ndiaye
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal
| | - O Fall
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal
| | - A Sow
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal
| | - I C Diakhaté
- Department of radiology, hôpital principal de Dakar, hôpital d'instruction des Armées, Dakar, Senegal
| | - M Ogougbémy
- Department of digestive surgery, hôpital principal de Dakar, hôpital d'instruction des armées, 1, Nelson Mandela avenue, BP 3006, Dakar, Senegal
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Shibuya N, Ishizuka M, Iwasaki Y, Takagi K, Nagata H, Aoki T, Kubota K. Usefulness of a laparoscopic approach for treatment of small-bowel obstruction due to intersigmoid hernia: a case report. Surg Case Rep 2017; 3:22. [PMID: 28161873 PMCID: PMC5292108 DOI: 10.1186/s40792-017-0298-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
It is well known that intersigmoid hernia (ISH) is a rare condition. Here we describe our experience of laparoscopic surgery for small-bowel obstruction (SBO) due to ISH after sufficient decompression involving long-tube insertion.A 45-year-old woman with no history of abdominal surgery visited our hospital with epigastric pain. She was diagnosed as having SBO and underwent long-tube insertion as conservative therapy. However, her symptoms did not improve. Gastrografin contrast enema via the long-tube demonstrated a beak sign in the lower left abdomen and CT showed incarcerated small bowel was successively covered by sigmoid mesocolon, suggesting that the SBO was due to ISH, and she underwent laparoscopic surgery after sufficient decompression of the dilated small bowel.Intraoperative examination demonstrated incarceration of a loop of the small bowel in the intersigmoid fossa without strangulation. Because the incarcerated portion of the small bowel was not necrotized, herniation repair was performed by removing the incarcerated small bowel from the intersigmoid fossa without closure of the hernia orifice.The postoperative course was uneventful, and the patient is now free of symptoms and recurrence 12 months after surgery. Laparoscopic surgery after sufficient decompression is a useful treatment for SBO due to ISH.
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Affiliation(s)
- Norisuke Shibuya
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Mitsuru Ishizuka
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Yoshimi Iwasaki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Kazutoshi Takagi
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Hitoshi Nagata
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Taku Aoki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Keiichi Kubota
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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83
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Tambe SV, Rana KK, Kakar A, Aggarwal S, Aggrawal A, Kakar S, Borkar N. Clinical importance of duodenal recesses with special reference to internal hernias. Arch Med Sci 2017; 13:148-156. [PMID: 28144266 PMCID: PMC5206374 DOI: 10.5114/aoms.2017.64717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 07/12/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The detailed knowledge of the peritoneal recesses has great significance with respect to internal hernias. The recesses are usually related to rotation and adhesion of abdominal viscera to the posterior abdominal wall and/or the presence of retroperitoneal vessels which raises the serosal fold. The duodenal recesses are usually related to the 3rd and 4th parts of the duodenum. Internal hernias with respect to these recesses are difficult to diagnose clinically and usually noticed at the time of laparotomy. So, the knowledge of these recesses can be valuable to abdominal surgeons. MATERIAL AND METHODS The present study was conducted in 100 cases including 10 cadavers, 45 post mortem cases and 45 cases undergoing laparotomy. RESULTS We found superior and inferior duodenal recesses in 28% and 52% respectively, paraduodenal in 12%, mesentericoparietal in 3%, retroduodenal in 2% and duodenojejunal in 18% of cases. Two abnormal duodenojejunal recesses were found, one on the right (instead of the left) of the abdominal aorta, and in the other the opening was directed upwards instead of downwards. The incidence of internal hernias was 3%. CONCLUSIONS Thus it was observed that there is low incidence of superior and inferior duodenal recesses, and high incidence of paraduodenal recess. The abnormal recesses might be due to malrotation of the gut. In laparotomy cases, the internal hernia was noticed when the abdomen was opened for intestinal obstruction. The incidence of internal hernia was found to be high.
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Affiliation(s)
- Shivpal V. Tambe
- Department of Anatomy, Government Medical College, Nagpur, India
| | - Kum Kum Rana
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Arun Kakar
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Satish Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Anil Aggrawal
- Department of Forensic Medicine and Toxicology, Maulana Azad Medical College, New Delhi, India
| | - Smita Kakar
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Nitinkumar Borkar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur, India
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84
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Morisue R, Inaba M, Shoji R, Kawamoto H. A case of combined laparoscopic reduction and open preperitoneal mesh repair for incarcerated small bowel in a retroperitoneal hernia between the external and internal iliac vessels. Hernia 2016; 21:657-660. [PMID: 27987048 DOI: 10.1007/s10029-016-1555-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
We report a rare case of an incarcerated retroperitoneal hernia with or involving the small bowel through the orifice between the right external and internal iliac vessels. A 39-year-old woman was admitted to our hospital because of vomiting and abdominal pain. She had a history of right oophorocystectomy and appendectomy. Abdominal computed tomography revealed small bowel obstruction resulting from an incarcerated retroperitoneal hernia. The small bowel herniated into the retroperitoneal fossa through the orifice between the right external and internal iliac vessels. Laparoscopic reduction of the small bowel was performed, followed by ligation of the sac and placement of a mesh prosthesis through the preperitoneal approach, using a lower midline incision along the previous laparotomy scar. Her postoperative course was uneventful and no recurrence has been observed after surgery.
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Affiliation(s)
- R Morisue
- Department of Surgery, Okayama Saiseikai General Hospital, 1-17-18 Ifuku, Kita, Okayama, 700-8511, Japan.
| | - M Inaba
- Department of Emergency, Okayama Saiseikai General Hospital, 1-17-18 Ifuku, Kita, Okayama, 700-8511, Japan
| | - R Shoji
- Department of Surgery, Okayama Saiseikai General Hospital, 1-17-18 Ifuku, Kita, Okayama, 700-8511, Japan
| | - H Kawamoto
- Department of Surgery, Okayama Saiseikai General Hospital, 1-17-18 Ifuku, Kita, Okayama, 700-8511, Japan
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85
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MDCT signs predicting internal hernia and strangulation in patients presented to emergency department with acute small bowel obstruction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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86
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A Rare Type of Primary Internal Hernia Causing Small Intestinal Obstruction. Case Rep Surg 2016; 2016:3540794. [PMID: 27999703 PMCID: PMC5141326 DOI: 10.1155/2016/3540794] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022] Open
Abstract
Primary internal hernias are extremely rare in adults. They are an important cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is nonspecific. Imaging has been of limited utility in cases of acute intestinal obstruction; moreover, interpretation of imaging features is operator dependant. Thus, internal hernias are usually detected at laparotomy and preoperative diagnosis in an emergency setting is either difficult or most of the time not suspected. We report herein a case of a 45-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the sigmoid colon in the left paracolic gutter. The segment of intestine was reduced and the hernial defect was closed. Our finding represents an extremely rare variant of retroperitoneal hernias.
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87
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Kumagai K, Yoshioka M, Iida M, Kudoh K, Uchinami H, Watanabe T, Yamamoto Y. Usefulness of Oblique Multiplanar Images on Multi-Detector Computed Tomography for Diagnosing Intersigmoid Hernia. Visc Med 2016; 32:437-440. [PMID: 28229081 DOI: 10.1159/000450633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intersigmoid hernia is a hernia of the small intestine into the intersigmoid fossa. Because the cavity of the intersigmoid fossa is so small, the preoperative detection of incarcerated intestine and/or mesenteric convergence is very difficult. We report a case of intersigmoid hernia in which the incarcerated bowel and mesenteric convergence could be visualized by oblique multiplanar reconstruction (MPR) images on multi-detector computed tomography (MDCT). CASE REPORT An 82-year-old man with small bowel obstruction was treated conservatively with a long intestinal tube. Axial plane images of MDCT detected only a thickening of the small bowel wall and a narrowing of the lumen in the pelvis. Since a fourteen-day waiting period did not improve the condition at all, he underwent surgery. The small bowel was herniated into the intersigmoid fossa. After surgery, we studied the preoperative images of MDCT once again. However, neither converged mesentery nor hernia orifice had been depicted. We attempted to make oblique coronal/sagittal MPR images using SYNAPSE VINCENT® and succeeded in visualizing not only the incarcerated bowels but also the hernia orifice and mesenteric convergence. CONCLUSION Creating oblique MPR images from the MDCT volume data would help in making a preoperative diagnosis of sigmoid mesocolon hernias such as intersigmoid hernia with increasing confidence.
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Affiliation(s)
- Kenta Kumagai
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Masato Yoshioka
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Masatake Iida
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Kudoh
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Uchinami
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Tasuku Watanabe
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuzo Yamamoto
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
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88
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Yazgan C, Sahin T, Ozmen M. Unusual cause of small bowel obstruction: mesodiverticular band of Meckel's diverticulum demonstrated by CT. BJR Case Rep 2016; 3:20150255. [PMID: 30363321 PMCID: PMC6159282 DOI: 10.1259/bjrcr.20150255] [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: 06/24/2015] [Revised: 09/07/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
Small bowel obstruction resulting from the mesodiverticular band is a rare complication of Meckel’s diverticulum and usually presents a diagnostic challenge. We present a case of small bowel obstruction due to the mesodiverticular band of Meckel’s diverticulum with CT scan findings.
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Affiliation(s)
- Cisel Yazgan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tolga Sahin
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mahir Ozmen
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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89
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Griffith D, Boal M, Rogers T. Peritoneal encapsulation; a rare cause of bowel obstruction. Ann R Coll Surg Engl 2016; 99:e11-e12. [PMID: 27502346 DOI: 10.1308/rcsann.2016.0264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Peritoneal encapsulation is a rare congenital cause of bowel obstruction in children. We present the case of a 12-year-old male with severe dehydration and recurrent episodes of vomiting. This pathology should be considered in cases of bowel obstruction with a virgin abdomen.
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Affiliation(s)
- Dgl Griffith
- Bristol Royal Hospital for Children , Bristol , UK
| | - M Boal
- Bristol Royal Hospital for Children , Bristol , UK
| | - T Rogers
- Bristol Royal Hospital for Children , Bristol , UK
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90
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Otani-Takei N, Akimoto T, Sadatomo A, Saito O, Muto S, Kusano E, Nagata D. Bowel Obstruction and Peritoneal Dialysis: A Case Report of a Patient with Complications from a Broad Ligament Hernia. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:57-60. [PMID: 27547042 PMCID: PMC4978204 DOI: 10.4137/ccrep.s40059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/23/2016] [Accepted: 06/28/2016] [Indexed: 12/21/2022]
Abstract
Abdominal hernias are a common cause of bowel obstruction. The major types of abdominal hernias are external or abdominal wall hernias, which occur at areas of congenital or acquired weakness in the abdominal wall. An alternative entity is internal hernias, which are characterized by a protrusion of viscera through the peritoneum or mesentery. We herein present the case of a female peritoneal dialysis patient with bowel obstruction due to an internal hernia. Although an initial work-up did not lead to a correct diagnosis, an exploratory laparotomy revealed that she had intestinal herniation due to a defect in the broad ligament of the uterus, which was promptly corrected by surgery. The concerns about the perioperative dialytic management as well as the diagnostic problems regarding the disease that arose in our experience with the present patient are also discussed.
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Affiliation(s)
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine
| | - Ai Sadatomo
- Department of Surgery, Jichi Medical University, Yakushiji, Shimotsuke-Shi, Tochigi, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine
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91
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Kheok SW, Haja Mohideen SM, Lim JWM, Santhosh Raj SR. Intramesosigmoid hernia complicated by strangulated small-bowel obstruction. BMJ Case Rep 2016; 2016:bcr-2016-216369. [PMID: 27432828 DOI: 10.1136/bcr-2016-216369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An intramesosigmoid hernia is 1 of the 3 rare types of sigmoid-related hernias that could be complicated by intestinal obstruction. Our patient presented with a clinical picture of intestinal obstruction. CT scan showed features of strangulated small-bowel obstruction secondary to a sigmoid-related hernia. This was confirmed intraoperatively to be an intramesosigmoid hernia. We share the radiological findings with intraoperative surgical correlation and discuss the imaging features described in the literature.
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Affiliation(s)
- Si Wei Kheok
- Department of Diagnostic Radiology, KK Women's and Children's Hospital, Singhealth Institution, Singapore, Singapore Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | | | - Jason Wei-Min Lim
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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92
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Leung E, Bramhall S, Kumar P, Mourad M, Ahmed A. Internal Herniation Through Foramen of Winslow: A Diagnosis Not to Be Missed. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2016; 9:31-3. [PMID: 27330337 PMCID: PMC4907339 DOI: 10.4137/cgast.s38453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality. METHOD We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on “PubMed” as a search platform using the keywords “foramen of Winslow” and “hernia”. CASE SUMMARY A 66-year-old man presented acutely with severe epigastric pain and vomiting. An emergency computed tomography scan revealed a loop of ileum in the lesser sac. At emergency laparotomy, a herniated loop of ileum that had become strangulated at its entry to the lesser sac via the foramen of Winslow was confirmed. The loop of ileum was reduced but was nonviable, which had to be resected with a primary anastomosis. The patient’s postoperative recovery was uneventful. CONCLUSION Herniation through the foramen of Winslow is a difficult diagnosis and must not be missed. Early cross-sectional imaging and surgical intervention are advised in order to reduce morbidity.
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93
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Tse G, Sollei T, Ali SM, Kukreja N. Caecal herniation through the foramen of Winslow. BJR Case Rep 2016; 2:20150330. [PMID: 30363613 PMCID: PMC6180871 DOI: 10.1259/bjrcr.20150330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 12/28/2022] Open
Abstract
Internal hernia is the protrusion of an abdominal viscus through the peritoneum or mesentery into a compartment within the abdominal cavity. We present a case of internal herniation through the foramen of Winslow that was identified by CT imaging. It was treated with reduction at laparotomy and subsequent right hemicolectomy.
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Affiliation(s)
- Gary Tse
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tamas Sollei
- Department of General Surgery, Medway Maritime Hospital, Kent, UK
| | | | - Neil Kukreja
- Department of General Surgery, Medway Maritime Hospital, Kent, UK
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94
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Wang W, Wang H, Tao F, Ai K. Strangulated lesser omentum hiatus hernia: a rare case report and a literature review. Int Surg 2016; 104:563-566. [PMID: 26982378 DOI: 10.9738/intsurg-d-15-00225.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intestinal obstruction caused by primary intraperitoneal hernia is infrequent and difficult to diagnose. Incorrect diagnosis and delayed surgical treatment will lead to serious consequences. We report a rare case of a 62-year-old Chinese woman with strangulated lesser omentum hiatus hernia. Contrast-enhanced abdominal computed tomography(CT) scan is recommended for early revealing direct and indirect signs. We propose three diagnostic points of primary intraperitoneal hernia: 1. "Three-no" pathography: with no history of abdominal operation, abdominal trauma and abdominal infection. 2. It begins with mechanical intestinal obstruction, then turns into strangulated intestinal obstruction easily. 3. Exclude intestinal wall lesions and intestinal blockage. We also summarize surgical procedure into four steps. We hope this case can provide a reference for the diagnosis and treatment of similar situations.
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Affiliation(s)
| | - Haifeng Wang
- 2 Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University
| | - Feng Tao
- 3 Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University
| | - Kaixing Ai
- 4 Tongji Hospital, Tongji University School of Medicine
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95
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Kim JW, Lee CH, Park CM. A Patient With Left Upper Abdominal Pain Who Had Petit Sac. Gastroenterology 2016; 150:e12-3. [PMID: 26829303 DOI: 10.1053/j.gastro.2015.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/23/2015] [Accepted: 08/10/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Min Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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96
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Ramos-Andrade D, Andrade L, Ruivo C, Portilha MA, Caseiro-Alves F, Curvo-Semedo L. Imaging the postoperative patient: long-term complications of gastrointestinal surgery. Insights Imaging 2015; 7:7-20. [PMID: 26638006 PMCID: PMC4729712 DOI: 10.1007/s13244-015-0451-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 11/24/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The objectives of this review are (1) to become acquainted with the long-term complications of surgery of the gastrointestinal tract, and (2) to appreciate the appropriate use of imaging in the assessment of long-term complications. BACKGROUND Gastrointestinal tract surgery comprises a group of procedures performed for a variety of both benign and malignant diseases. In the late postoperative setting, adhesions and internal hernias are the most important complications. and they can be further complicated by volvulus and ischemia. At present, computed tomography (CT) is the workhorse for evaluating late postoperative complications. Accurate imaging assessment of patients is essential for adequate treatment planning. IMAGING FINDINGS OR PROCEDURE DETAILS In this pictorial essay we will review the most frequent long-term complications after gastrointestinal surgery, including adhesions, afferent loop syndrome, closed-loop obstruction, strangulated obstruction, internal hernias, external hernias, anastomotic strictures and disease recurrence. Examples will be depicted using iconography from the authors' imaging department. CONCLUSIONS Knowledge of the most frequent complications after gastrointestinal surgery in the late postoperative period is of paramount importance for every radiologist, so that potentially life-threatening situations can be promptly diagnosed and adequate therapy can be planned. TEACHING POINTS • Long-term postoperative complications of gastrointestinal tract surgery can be divided into procedure-related and disease-related categories. • The most common procedure-related complications are internal hernias and adhesions. • The most frequent disease-related complications are mainly associated with neoplastic or inflammatory recurrence. • Computed tomography is the most useful examination when such complications are suspected.
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Affiliation(s)
- Daniel Ramos-Andrade
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Luísa Andrade
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Catarina Ruivo
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | | | - Filipe Caseiro-Alves
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Curvo-Semedo
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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97
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Bellini D, Maceroni MM, Cavallaro G, De Santis D, Iorio O, Rengo M, Silecchia G, Laghi A. CT diagnosis of small bowel obstruction caused by internal hernia from persistent attachment of a Meckel's diverticulum to the umbilicus by the obliterated omphalomesenteric duct. BJR Case Rep 2015; 2:20150131. [PMID: 30364359 PMCID: PMC6195940 DOI: 10.1259/bjrcr.20150131] [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: 03/25/2015] [Revised: 11/05/2015] [Accepted: 11/10/2015] [Indexed: 11/06/2022] Open
Abstract
We report a case of small bowel obstruction (SBO) caused by internal hernia from persistent attachment of a Meckel’s diverticulum (MD) to the umbilicus by the obliterated omphalomesenteric duct that was diagnosed by multidetector CT and confirmed during laparoscopic surgery. Although clinical, pathological and radiological features of MD and its complications are well known, the diagnosis of MD is difficult to establish preoperatively. CT findings that allow the diagnosis of this very unusual cause of SBO are presented here with laparoscopic surgery correlation.
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Affiliation(s)
- Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza-University of Rome, Latina, Italy
| | - Marco Maria Maceroni
- Department of Radiological Sciences, Oncology and Pathology, Sapienza-University of Rome, Latina, Italy
| | - Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Domenico De Santis
- Department of Radiological Sciences, Oncology and Pathology, Sapienza-University of Rome, Latina, Italy
| | - Olga Iorio
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza-University of Rome, Latina, Italy
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza-University of Rome, Latina, Italy
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98
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Doishita S, Takeshita T, Uchima Y, Kawasaki M, Shimono T, Yamashita A, Sugimoto M, Ninoi T, Shima H, Miki Y. Internal Hernias in the Era of Multidetector CT: Correlation of Imaging and Surgical Findings. Radiographics 2015; 36:88-106. [PMID: 26587890 DOI: 10.1148/rg.2016150113] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Clinical diagnosis of internal hernias is challenging because of their nonspecific signs and symptoms. Many types of internal hernias have been defined: paraduodenal, small bowel mesentery-related, greater omentum-related, lesser sac, transverse mesocolon-related, pericecal, sigmoid mesocolon-related, falciform ligament, pelvic internal, and Roux-en-Y anastomosis-related. An internal hernia is a surgical emergency that can develop into intestinal strangulation and ischemia. Accurate preoperative diagnosis is crucial for appropriate management. Multidetector computed tomography (CT), with its thin-section axial images, high-quality multiplanar reformations, and three-dimensional images, currently plays an essential role in preoperative diagnosis of internal hernias. The diagnostic approach to internal hernias at multidetector CT includes detecting an intestinal closed loop, identifying the hernia orifice, and analyzing abnormal displacement of surrounding structures and key vessels around the hernia orifice and hernia sac. At each step, multidetector CT can depict pathognomonic findings. A saclike appearance suggests an intestinal closed loop in several types of internal hernias. Convergence, engorgement, and twisting of mesenteric vessels in the hernia orifice can be seen clearly at multidetector CT, especially with use of multiplanar reformations. For definitive diagnosis of an internal hernia, analysis of displacement of anatomic landmarks around the hernia orifice is particularly important, and thin-section images provide the required information. Detailed knowledge of the anatomy, etiology, and imaging landmarks of the various hernia types is also necessary. Familiarity with the appearances of internal hernias at multidetector CT allows accurate and specific preoperative diagnosis. (©)RSNA, 2015.
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Affiliation(s)
- Satoshi Doishita
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Tohru Takeshita
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Yasutake Uchima
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Masayasu Kawasaki
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Taro Shimono
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Akiyoshi Yamashita
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Michiko Sugimoto
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Teruhisa Ninoi
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Hideki Shima
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
| | - Yukio Miki
- From the Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (S.D., T.T., T.S., Y.M.); Department of Surgery, Fuchu Hospital, Izumi, Japan (Y.U.); Department of Surgery, Bell Land General Hospital, Sakai, Japan (M.K.); Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan (A.Y.); Department of Radiology, Japan Community Healthcare Organization (JCHO) Osaka Hospital, Osaka, Japan (M.S.); Department of Radiology, Perfect Liberty Hospital, Tondabayashi, Japan (T.N.); and Department of Radiology, Narita Red-Cross Hospital, Narita, Japan (H.S.)
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Paliogiannis P, Delogu L, Contu G, Cambilargiu AL, Mundula A, Sotgiu G, Biddau C, Attene F, Trignano M, Scognamillo F. Small bowel emergencies: two surgical centers’ experience and literature review. Eur Surg 2015. [DOI: 10.1007/s10353-015-0356-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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100
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Internal Hernia as a Cause for Intestinal Obstruction in a Newborn. J Emerg Med 2015; 49:277-80. [PMID: 26145885 DOI: 10.1016/j.jemermed.2015.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 04/01/2015] [Accepted: 04/16/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND An internal hernia is a rare cause of intestinal obstruction, which can occur at any age. Children most often develop an internal hernia due to a congenital defect in the mesentery. While some patients are asymptomatic, others present to medical attention with vague abdominal symptoms, an acute abdomen, or in shock. CASE REPORT We report a case of a 5-day-old previously healthy baby who presented to our pediatric emergency department with bilious vomiting, grossly bloody stool, and abdominal distention. During an exploratory laparotomy, the patient was diagnosed with an internal hernia caused by a congenital mesenteric defect. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although internal hernia is an infrequent cause of intestinal obstruction in a newborn and requires emergent operative repair, it may be mistaken for other more common causes, such as necrotizing entercolitis, which are often managed medically. This case report aims to highlight some of the difficulties in diagnosis and key features that may assist the clinician in identifying these patients.
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