Pericecal hernia in a pediatric patient: Case report and literature review

Laparoscopic Management of Para-Caecal Hernia With Small Bowel Obstruction: A Case Report

Para-caecal hernias are a rare type of internal hernias. They can cause bowel obstruction, leading to strangulation of the bowel. As such, urgent diagnosis and appropriate management are important. Both laparoscopic and open approaches are options in terms of surgical treatment. We report a case of a para-caecal hernia causing small bowel obstruction and highlight the laparoscopic approach as a feasible and effective way of management.

A Fatal Case of Strangulated Pericecal Hernia

Pericecal hernia, a subtype of internal hernia, is a rare and unusual cause of small-bowel obstruction (SBO). We report the case of a pericecal hernia in an 80-year-old woman who presented to the emergency department with symptoms of SBO. She experienced colicky diffuse abdominal pain associated with vomiting and obstipation for over five days. Abdominal examination showed rebound tenderness in the right iliac fossa without any mass palpation. Computed tomography noted a "sac-like" structure in the right iliac fossa with dilated and ischemic small-bowel loops within. Exploratory laparotomy showed strangulated pericecal hernia and non-viable small bowel loops in the inferior ileocecal recess. Extensive resection and defect repair followed by small-bowel end-to-end primary anastomosis was made. After two days of ICU admission, patient died from septic shock. This case report highlights the need for prompt diagnosis, followed by surgical intervention to lower mortality of SBO of internal hernia origin, especially in cases where no previous surgery is noted.

Laparoscopic management of a small bowel obstruction caused by an unusual pericecal hernia: Case report

INTRODUCTION

Pericecal hernia is a rare type of internal hernia and may present with unspecific signs and symptoms. Thus, preoperative recognition of pericecal hernias can be challenging and difficult.

CASE PRESENTATION

We present a case of pericecal hernia in a rare location that was managed laparoscopically. A 63-year-old medically free gentleman presented to the emergency room with clinical and radiographic evidence of small bowel obstruction. An abdominal computed tomographic scan showed diffuse small bowel dilation and a transitional zone at the distal illeal loop near the ileocecal junction. The patient was admitted and started on conservative management. Two days later, there was no improvement in the patient's situation, and the patient underwent laparoscopic exploration where part of the distal ileum was seen going through a mesenteric defect superior to the ileocecal valve. The herniated bowel was reduced, and the hernia orifice was closed with sutures. The patient was discharged at day 9 postoperatively with excellent clinical and radiographic findings during the postoperative period.

DISCUSSION

Pericecal hernia in the superior ileocecal recess is the least common location for this type of hernia. Previously, laparoscopic management of small bowel obstruction was not recommended. However, recent evidence has shown excellent outcomes of laparoscopic management of pericecal hernia.

CONCLUSION

In pericecal hernia, having a high index of suspicion may help prevent delayed diagnosis and management. Laparoscopic exploration is a safe and acceptable modality for the diagnosis and treatment of small bowel obstruction due to pericecal hernias.

Laparoscopic treatment of a pericaecal internal hernia

We present the case of a pericaecal hernia treated successfully with a laparoscopic approach and full recovery after surgery. A 53-year-old female patient with a personal history of depression, osteoporosis and irritable bowel syndrome consulted to the emergency department for abdominal pain and distension in the last 12 h, associated with one episode of vomit and diminished frequency in the passage of stools. The right abdomen was tender to palpation, and blood work revealed no leucocytosis. A computed tomography scan showed small bowel loops distended and displaced to the right parietocolic recess, lateral to the ascending colon. Exploratory laparoscopy was performed confirming the presence of small bowel loops incarcerated in the paracaecal fossa. These ones were reduced with gentle manoeuvres, and the peritoneal folds incised to prevent recurrence. The patient was started on an oral diet 2 days after surgery and discharged home on the 3^rd post-operative day.

Paracecal hernia due to membranous adhesion of the omentum to the right paracolic gutter

BACKGROUND

Paracecal hernias, also known as pericecal hernias, are an exceptionally rare type of internal hernia. We report a unique case of paracecal hernia due to membranous adhesion of the omentum to the right paracolic gutter.

CASE PRESENTATION

An 86-year-old female was admitted to our hospital with vomiting and abdominal pain. Laboratory findings showed a slightly elevated C-reactive protein level. Computed tomography scan showed dilated loops of the small intestine in the right paracolic gutter with medial displacement of the cecum and ascending colon. Internal hernia around the cecum due to postoperative adhesion after appendectomy was suspected, and she underwent emergency laparotomy. Intraoperative findings revealed the adhesion between the omentum and right paracolic gutter forming a cavity with the small intestine incarcerated. No abnormal adhesion in the ileocecal region was seen. We transected the omental adhesion from the orifice to the far end of the cavity near the hepatic flexure of the colon to release strangulation and to prevent recurrence. The patient was discharged on postoperative day 14 without complications.

CONCLUSIONS

Paracecal hernias have a type of membranous adhesion of the omentum to the right paracolic gutter. Surgeons should be aware of this paracecal hernia type, when they encounter the internal hernia.