1
|
Matsuishi K, Saito S, Ohuchi M, Kiyozumi Y, Nasu J, Hanada N, Baba H. A case of internal hernia in the pararectal fossa. Surg Case Rep 2023; 9:178. [PMID: 37843687 PMCID: PMC10579196 DOI: 10.1186/s40792-023-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/02/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Internal hernias are relatively rare and difficult to diagnose. Diagnostic delays lead to the progression of strangulation. In particular, pararectal fossa hernias are extremely rare. We encountered a case in which internal hernia occurred in the pararectal fossa. CASE PRESENTATION An 87-year-old woman was referred to our hospital because of persistent lower abdominal pain and vomiting. Contrast-enhanced computed tomography revealed findings of intestinal ischemia, such as closed loop formation with reduced contrast effect on the left side of the rectum in the pelvis. Strangulation small bowel obstruction was diagnosed, and emergency laparotomy was performed. The small intestine was found to invade the peritoneal reflection on the left side of the rectum. The patient was finally diagnosed with pararectal fossa hernia. The incarcerated small intestine was released with no bowel resection. The 4-cm hernia phylum was observed and closed by simple suture. The patient had a good postoperative course without recurrence. CONCLUSIONS We encountered a very rare case of internal hernia in the left pararectal fossa. Preoperative diagnosis of this disease is difficult, but it should nevertheless be considered in cases in which the cause of the intestinal obstruction is unknown.
Collapse
Affiliation(s)
- Kozue Matsuishi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Seiya Saito
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Mayuko Ohuchi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Yuki Kiyozumi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Jiro Nasu
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Norihisa Hanada
- Department of Surgery, Izumi General Medical Center, 520 Myozincho, Izumi City, Kagoshima, 899-0131, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
| |
Collapse
|
2
|
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.
Collapse
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.)
| |
Collapse
|