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Sekai I, Minaga K, Hara A, Otsuka Y, Masuta Y, Shigeoka H, Watanabe T, Kudo M. Transmesenteric internal hernia: an unexpected adverse event induced by colonoscopy. Clin J Gastroenterol 2024:10.1007/s12328-024-02013-x. [PMID: 38961027 DOI: 10.1007/s12328-024-02013-x] [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: 04/16/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
Transmesenteric internal hernia is an uncommon cause of small bowel obstruction that occurs when small bowel loops protrude through a mesenteric defect into the abdominal cavity. Herein, we present an unexpected case of colonoscopy-induced transmesenteric internal hernia. An 81-year-old male patient presenting with intermittent hematochezia and constipation had undergone a laparoscopic left nephrectomy for ureteral cancer. A colonoscopy was performed to identify the etiology of his symptoms. He complained of severe abdominal pain 2 h after the examination despite uneventful endoscopic procedures, including cold snare polypectomy. Contrast-enhanced computed tomography revealed a strangulated small bowel obstruction with a closed-loop formation outside the descending colon. The small bowel loop was incarcerated into the left retroperitoneal space. Emergency laparotomy detected small bowel loops that prolapsed into the nephrectomy pedicle via a descending mesenteric defect, developed during the laparoscopic left nephrectomy. The incarcerated small bowel was detached from the hernia and returned to its normal position, and the mesenteric defect was closed. He demonstrated an uneventful postoperative course, with no internal hernia recurrence after discharge. This case indicates the risk of transmesenteric internal hernia through inadvertently created mesenteric defects should be borne in mind, especially when performing colonoscopies in patients who underwent laparoscopic nephrectomies.
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Affiliation(s)
- Ikue Sekai
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Ohno-Higashi 377-2, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Ohno-Higashi 377-2, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Akane Hara
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Ohno-Higashi 377-2, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yasuo Otsuka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Ohno-Higashi 377-2, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yasuhiro Masuta
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Ohno-Higashi 377-2, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Hironori Shigeoka
- Department of Acute Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Ohno-Higashi 377-2, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Ohno-Higashi 377-2, Osaka-Sayama, Osaka, 589-8511, Japan
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Pal NL, Panandiker SD, Katiyar G, Vernekar JA. Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist. Emerg Radiol 2024:10.1007/s10140-024-02256-8. [PMID: 38926239 DOI: 10.1007/s10140-024-02256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.
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Affiliation(s)
- Nilkanth L Pal
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India.
| | - Swamini D Panandiker
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Glory Katiyar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Jeevan A Vernekar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
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3
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Golden E, Brookmeyer C, Gomez E. Don't be thrown for a loop: a review of internal hernias for the abdominal imager. Abdom Radiol (NY) 2024:10.1007/s00261-024-04426-1. [PMID: 38916615 DOI: 10.1007/s00261-024-04426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/26/2024]
Abstract
Internal hernias are herniations of abdominal viscera, usually small bowel, through congenital or acquired openings of the peritoneum or mesentery. Congenital hernias may involve anatomic fossae such as the epiploic foramen as well as those related to abnormal peritoneal or mesenteric defects; these include left and right paraduodenal, transomental, transmesenteric, pericecal and broad ligament hernias. Acquired hernias are due to defects in the mesentery or peritoneum, usually resulting from prior surgeries, and include those associated with Roux-en-Y surgery as well as colorectal cancer resections. Internal hernias account for 5.8% of small obstructions. Obstructed internal hernias are considered surgical emergencies due to the high risk of bowel strangulation. This review summarizes the various types of congenital and acquired internal hernias, their relevant anatomy, embryology, associated surgical history and imaging appearance. We will also discuss a location-based approach to identifying internal hernias on CT, as well as complications and relevant signs, of which abdominal imagers should be vigilant.
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Affiliation(s)
- Edwarda Golden
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD, 21287, USA.
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Claire Brookmeyer
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD, 21287, USA
| | - Erin Gomez
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD, 21287, USA
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Khedr S, Abdelmohsen SM, Abdelazim O. Mesocolic hernia, a case series. Int J Surg Case Rep 2024; 119:109696. [PMID: 38714067 PMCID: PMC11098949 DOI: 10.1016/j.ijscr.2024.109696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Paraduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature. CASE PRESENTATION Four male and one female child complained of paraduodenal hernias, two on the right side and three on the left side. The intestinal part that herniated inside the hernia sac was also malrotated in four patients. One patient had Meckel's diverticulum with a herniated intestine. One infant had extrahepatic biliary disease, a single atrium, polysplenia, intestinal malrotation, and a left paraduodenal hernia. Exploratory labarotomy was done for reduction of the intestine, reorientation, and repair of hernia orifices. CLINICAL DISCUSSION Paraduodenal hernia is a component of malrotation. Cautious dissection of the hernia orifice is required to keep away from injuries to the inferior mesenteric vein or left colic artery in the course of the restoration of the left paraduodenal hernia. Also, the superior mesenteric vessels may be injured in the course of the restoration of the right paraduodenal hernia. CONCLUSION There is a correlation between the occurrence of PDH with malrotation. The diagnosis of malrotation can be made with an ultrasound abdomen; however, it is true that ultrasound cannot make a confirmed diagnosis in all patients. Once the diagnosis of a mesocolic hernia has occurred, surgical repair is mandatory by closure of the defect.
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Affiliation(s)
- Sayed Khedr
- Lecturer of Pediatric Surgery at Cairo University Children Hospital, Cairo University, Egypt
| | | | - Osama Abdelazim
- Lecturer of Pediatric Surgery at Cairo University Children Hospital, Cairo University, Egypt
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Brogna B, Urciuoli L, Musto LA, Iovine L. A late presentation of a left paraduodenal hernia in an elderly patient admitted in emergency: A case report. Radiol Case Rep 2024; 19:1356-1360. [PMID: 38288049 PMCID: PMC10823032 DOI: 10.1016/j.radcr.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.
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Affiliation(s)
- Barbara Brogna
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Luigi Urciuoli
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Lanfranco Aquilino Musto
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Lorenzo Iovine
- Department of Surgical Emergency, San Giuseppe Moscati Hospital, Avellino, Italy
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Ogunleye O, Abdelhafez AH, Matta E, Kramer L. Retrorectal Hernia: A Rare Cause of Constipation Diagnosed on Magnetic Resonance (MR) Defecography. Cureus 2024; 16:e58848. [PMID: 38784319 PMCID: PMC11112525 DOI: 10.7759/cureus.58848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Retrorectal herniation of the sigmoid colon is a rare condition characterized by the protrusion of a segment of the colon into the pre-sacral space and posterior to the rectum. This herniation occurs through a defect in the peritoneum, which may have developed secondary to congenital mechanisms, surgery, trauma, or inflammatory processes. Here, a case of retrorectal herniation of the sigmoid colon in an elderly female patient presenting with constipation is reported, with a review of the literature.
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Affiliation(s)
- Olanrewaju Ogunleye
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
| | - Abeer H Abdelhafez
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
| | - Eduardo Matta
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
| | - Larry Kramer
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, USA
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Devi P, Hatgaonkar A, Tanksale V, Dhawan V, Kamble A, Jobanputra M. A Case Report on Internal Hernia as an Unusual Cause of Small Bowel Obstruction: A Diagnostic Triumph Unveiled by Computed Tomography Scan. Cureus 2024; 16:e55526. [PMID: 38576692 PMCID: PMC10992731 DOI: 10.7759/cureus.55526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Paraduodenal hernia is a type of internal hernia caused by defects in the peritoneum during fetal development. It is one of the uncommon causes of intestinal obstruction; diagnosing it and intervening promptly are required. In this case report, we describe our experience treating an adult male patient who presented with symptoms of acute small bowel obstruction and was later diagnosed with internal hernia on further evaluation. The purpose of this case report is to demonstrate the importance of imaging modalities, particularly computed tomography (CT) scan, in diagnosing these cases. Because of their mysterious symptoms, paraduodenal hernias are usually diagnosed late or incidentally. Although they are uncommon, they are far more likely to cause bowel obstruction and strangulation. Immediate surgical intervention is required following the diagnosis.
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Affiliation(s)
- Pavithra Devi
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anand Hatgaonkar
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | | | - Vaishali Dhawan
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Akhilesh Kamble
- General Surgery, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Meet Jobanputra
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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8
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Matsuura T, Satani N, Tamura R, Kagaya Y, Yamada T. Falciform ligament hernia: combination of key CT findings. Radiol Case Rep 2023; 18:2039-2042. [PMID: 37006834 PMCID: PMC10050677 DOI: 10.1016/j.radcr.2023.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 04/04/2023] Open
Abstract
A male patient in his early 90s with no history of abdominal surgery was referred to us for abdominal pain and vomiting. An abdominal computed tomography (CT) demonstrated dilated small bowel with a double beak sign and poorly enhanced wall, which indicated a closed-loop obstruction that leads to strangulation. A closed-loop bowel was located in front of the anterior and medial segments of the liver and to the right of the round ligament of the liver on axial images. Sagittal images revealed that the round ligament has deviated downward and 2 adjacent narrowed intestines were located at its cranial side. These CT findings suggested the hernia orifice was in the falciform ligament. Emergency surgery for highly suspected bowel ischemia revealed the falciform ligament hernia. A combination of the CT findings played a key role, including the double beak sign, the location of the closed-loop small bowel, and the downward deviation of the round ligament, although preoperative CT diagnosis of falciform ligament hernia is a diagnostic challenge.
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9
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Swenson Z, Kinariwala D, Moneme C, McGahren E, Daugherty R. Congenital internal hernia in the neonate: Case series with review of potential comorbidities and imaging findings. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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10
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging pearls and differential diagnosis of encapsulating peritoneal sclerosis: Emphasis on computed tomography. Clin Imaging 2023; 94:116-124. [PMID: 36527797 DOI: 10.1016/j.clinimag.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/20/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction most frequently identified as a complication of peritoneal dialysis. EPS is a complex condition whose management requires multidisciplinary input from radiologists, gastroenterologists, nephrologists, surgeons, and dietitians. EPS carries significant morbidity and mortality, primarily due to bowel obstruction that results in intestinal failure, malnutrition, and sepsis. The nondialysis causes of EPS include tuberculous peritonitis, prior abdominal surgery, beta-blocker medication use, and endometriosis. The clinical symptoms of EPS are nausea, vomiting, and abdominal pain, all of which appear to be associated with bowel obstruction. The diagnosis of EPS needs three pillars to be met: clinical features, radiological evaluation, and histopathological analysis. The disease is frequently progressive and can be fatal. Computed tomography is the gold standard imaging modality for the detection of peritoneal abnormalities and encapsulation of bowel loops by thick adhesions or fibrosis (cocooning). Computed tomography also aids in making a differential diagnosis. Unfortunately, the diagnosis of EPS is often delayed because clinical findings are not specific and may resemble other peritoneal diseases. Radiologists should be familiar with the clinical impacts and related imaging features of EPS and realize when to seek them to facilitate timely and proper treatment.
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Affiliation(s)
- Sitthipong Srisajjakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Patcharin Prapaisilp
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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11
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Pentakota N, Abuji K, Vaddavalli VV, Sakaray Y. Retrocecal hernia with small bowel obstruction: a review of literature. BMJ Case Rep 2023; 16:e252355. [PMID: 36631169 PMCID: PMC9835861 DOI: 10.1136/bcr-2022-252355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Retrocecal hernia, a type of internal hernia, is a rare cause of small bowel obstruction. It can come as a surprise to the operating surgeon if not diagnosed preoperatively. We hereby report a case of retrocecal hernia presenting with small bowel obstruction. A man in his early 60s presented to the emergency department with recurrent episodes of vomiting associated with abdominal pain for 3 days and the inability to pass flatus for 1 day. Preoperative imaging revealed multiple air-fluid levels with a transition point in the terminal ileum suggestive of small bowel obstruction. After adequate resuscitation, emergency laparotomy was performed, and intraoperatively, herniated ileal loop through a retrocecal defect was identified as a cause of obstruction. Herniated ileal loop was reduced, followed by the closure of the defect and cecopexy. The postoperative course was uneventful, and the patient was discharged in a stable condition. He was asymptomatic on follow-up.
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Affiliation(s)
- Naveen Pentakota
- General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kishore Abuji
- General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Yashwant Sakaray
- General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Lamprou V, Krokou D, Karlafti E, Panidis S, Kougias L, Tzikos G, Ioannidis A, Netta S, Thomaidou E, Paramythiotis D. Right Paraduodenal Hernia as a Cause of Acute Abdominal Pain in the Emergency Department: A Case Report and Review of the Literature. Diagnostics (Basel) 2022; 12:2742. [PMID: 36359585 PMCID: PMC9689437 DOI: 10.3390/diagnostics12112742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 01/27/2024] Open
Abstract
Paraduodenal hernias (PDHs) represent an unusual cause of acute abdominal pain in the Emergency Department (ED) and are associated with high morbidity attributable to a challenging clinical and radiological diagnosis, as signs and symptoms mimic other frequent causes of acute abdominal pain. We report a right paraduodenal hernia in a 37-year-old female patient who presented to the ED complaining of abdominal pain located in the right lower abdomen and hypogastrium, accompanied by nausea. During diagnostic work up, the abdominal computed tomography scan revealed the presence of small bowel malrotation with concomitant right paraduodenal hernia. These findings were confirmed intraoperatively. We performed a brief literature review about the clinical manifestations and treatment options of right paraduodenal hernias, which retrieved only 30 articles related to this condition. Prompt diagnosis, radiological or intraoperative, of paraduodenal hernias is crucial because nearly 50% will progress to small bowel obstruction. Therefore, it is essential for every clinician to account for them in the differential diagnosis of acute abdominal pain in the ED.
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Affiliation(s)
- Viktoria Lamprou
- Radiology Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Despoina Krokou
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stavros Panidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Leonidas Kougias
- Department of Interventional Radiology, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Georgios Tzikos
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Aristeidis Ioannidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Smaro Netta
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Evanthia Thomaidou
- Department of Anesthesia and Intensive Care, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Daniel Paramythiotis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
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13
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Kharkhach A, Police A, Mabilia A, Charre L. Foramen of Winslow hernia: a case report of a rare life-threatening situation. J Surg Case Rep 2022; 2022:rjac364. [PMID: 36072650 PMCID: PMC9439694 DOI: 10.1093/jscr/rjac364] [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: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
Internal hernias through the foramen of Winslow are considered as rare events. A 66-year-old female patient presented to our emergency department with epigastric and right upper quadrant pain associated with abdominal distention, nausea and vomiting and signs of shock. A computed tomography scan showed bowel strangulation with distended loops identified within the lesser sac. The diagnosis was confirmed by a midline laparotomy procedure. The ileum, the caecum and the ascending colon were found to herniate into the foramen of Winslow. A right hemicolectomy with a resection of the necrotic segment was performed. The patient recovered well postoperatively and was discharged on 10th day after surgery. The diagnosis and management of this rare disease remains challenging. Cross-sectional imaging with reconstruction is considered as the diagnostic modality of choice. Moreover, right hemicolectomy is a preferred procedure in order to decrease the rate of recurrence.
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Affiliation(s)
- Ayoub Kharkhach
- Department of Viscéral Surgery , Faculty of Medicine and Pharmacy, , Oujda , Morocco
- Mohammed Ist University , Faculty of Medicine and Pharmacy, , Oujda , Morocco
| | - Andrea Police
- Department of Visceral and Digestive Surgery, Simone Veil Hospital , Eaubonne , France
| | - Andrea Mabilia
- Department of Visceral and Digestive Surgery, Simone Veil Hospital , Eaubonne , France
| | - Lionel Charre
- Department of Visceral and Digestive Surgery, Simone Veil Hospital , Eaubonne , France
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Kanamori K, Ogimi T, Chan LF, Miyakita H, Okada K, Kayano H, Mori M, Nakagohri T, Koyanagi K, Yamamoto S. Internal hernia caused by bridge formation between the medial and lateral segments of the liver: a case report. BMC Gastroenterol 2022; 22:285. [PMID: 35659254 PMCID: PMC9166352 DOI: 10.1186/s12876-022-02294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite numerous reports on ischemic bowel obstruction caused by internal hernia, no case presentation has been reported of an internal hernia caused by a bridge formed between the medial and lateral zones of the liver. Herein, we report the first case of ischemic bowel obstruction caused by a hepatic bridge. Case presentation A 24-year-old man complaining of abdominal pain was referred to our hospital and admitted. Computed tomography showed formation of a closed loop of small bowel with a hernia orifice near the hilar region, and poor contrast of the prolapsed small bowel. We suspected ischemic bowel obstruction caused by an internal hernia with a fissure of the greater omentum as the hernia orifice, and performed emergency surgery. Laparoscopic observation revealed that the medial and lateral segments of the liver formed a bridge on the dorsal side at the liver portal, and that the small intestine was ischemic in the gap created between the bridge and the medial and lateral liver segments. A Meckel’s diverticulum was also invaginated in the gap. The bridge was dissected out and the hernia orifice was opened to release the bowel obstruction. The small bowel was preserved and the Meckel’s diverticulum was resected. The patient’s postoperative course was uneventful. Conclusions We experienced a case of ischemic bowel obstruction caused by hepatic bridge formation, which was successfully treated by laparoscopic surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02294-x.
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Xianqing S, Jian S, Wei S. Congenital mesocolon bands:A rare cause of incarcerated internal hernia. Asian J Surg 2022; 45:959-961. [PMID: 35000848 DOI: 10.1016/j.asjsur.2021.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Song Xianqing
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China
| | - Song Jian
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China
| | - Sun Wei
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China.
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16
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Esmat HA, Naseri MW. Small bowel obstruction due to internal herniation through a defect in the falciform ligament: a rare case report and review of the literature. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The falciform ligament hernia is a type of internal herniation, caused by a defect in the falciform ligament of the liver. The etiology for this defect may be congenital or iatrogenic, created after the laparoscopic intervention.
Case presentation
A 45-year-old male was presented to our hospital, complaining of abdominal pain for 2 days. The physical examination revealed diffuse abdominal tenderness and guarding. The abdominal X-ray was suggestive of intestinal obstruction. On abdominal CT images, dilated proximal ileal loops between the left hepatic lobe and anterior abdominal wall, forming a closed-loop with mesenteric edema and fat stranding, were observed. There were findings of ileus in the jejunal loops proximal to this segment, but the ileal loops and the colon were completely collapsed, consistent with small bowel obstruction due to internal herniation through a defect in the falciform ligament. The patient underwent surgical intervention, reduction of the herniated bowel loops, and repairing the hernia defect. He had an uneventful recovery with a favorable outcome.
Conclusion
Herniation through a defect in the falciform ligament is extremely rare but should be considered in the differential diagnosis of acute abdomen. The clinical manifestations of falciform ligament hernia are nonspecific and may underestimate the diagnosis, leading to a delayed treatment that affects the management outcome. Computed tomography plays an important role in the timely diagnosis and planning of surgical intervention, precluding intestinal strangulation.
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17
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Khaled C, Akl M, Moussallem T. A Unique Case of Small Bowel Internal Hernia and Volvulus Caused by a Hamartoma. Surg J (N Y) 2021; 7:e209-e211. [PMID: 34414262 PMCID: PMC8370791 DOI: 10.1055/s-0041-1733832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/07/2021] [Indexed: 11/04/2022] Open
Abstract
This study depicts the case of a young female presenting with intestinal obstruction. Surgery uncovered a small bowel hamartoma that has caused a transmesenteric internal hernia and volvulus. As far as we know, this is unheard of before, as all three mentioned entities are very rare. The study also covers a literature review of cases of internal hernia with volvulus and stresses over the need for urgent diagnosis and management.
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Affiliation(s)
- Charif Khaled
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Michel Akl
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Toufic Moussallem
- Department of General Surgery, General and Laparoscopic Surgeon, Sacred Heart Hospital, Beirut, Lebanon
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18
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Xianqing S, Wei S, Zhixian L. Laparoscopic repair of a congenital internal hernia due to peritoneal aperture: A case report. Asian J Surg 2021; 44:1328-1329. [PMID: 34330589 DOI: 10.1016/j.asjsur.2021.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Song Xianqing
- General Surgery Department, Ningbo, No.4 Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan Country, Ningbo, Zhejiang, 315000, PR China.
| | - Sun Wei
- General Surgery Department, Ningbo, No.4 Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan Country, Ningbo, Zhejiang, 315000, PR China
| | - Liu Zhixian
- Proctology Department, Beilun People's Hospital of Ningbo, No. 1288 Lushan East Road, Beilun District, Ningbo, Zhejiang, 315000, PR China
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19
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Sajan A, Hakmi H, Griepp DW, Sohail AH, Liu H, Halpern D. Herniation Through Defects in the Broad Ligament. JSLS 2021; 25:JSLS.2020.00112. [PMID: 34248336 PMCID: PMC8241289 DOI: 10.4293/jsls.2020.00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background We sought to assess hernia characteristics and classification through comprehensive review of the literature involving broad ligament herniation. Methods A literature search via MEDLINE and Embase databases was conducted to identify and select broad ligament herniation studies published between January 1, 2000 and September 30, 2020. Extracted data included previous surgical history, previous obstetric history, diagnostic imaging, herniated organ, hernia classification, and repair performed. The reported data has been compared to a unique case of broad ligament herniation that presented to our institution. Results A total of 44 articles with 49 cases were identified for the study. Eighteen (36.7%) patients had a history of previous abdominal surgery while 29 (59.2%) had a history of previous childbirth. Type I (51.0%) and Type II (18.4%) defects were most commonly reported with most patients reporting only one defect (85.7%) using the Cilley classification. Twenty-nine patients underwent primary laparoscopic repair of the defect while 19 patients underwent exploratory laparotomy. Conclusions The analysis of previously reported cases adds to the limited literature on broad ligament hernias and highlights the surgical management of this uncommon pathology. It also highlights the need for a broad differential diagnosis when female patients present with pelvic pain or symptoms of small bowel obstruction. The broad ligament should be fully inspected when mesenteric defects are suspected as multiple defects can be present as evidenced by the attached case study.
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Affiliation(s)
- Abin Sajan
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Hazim Hakmi
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Daniel W Griepp
- College of Medicine, New York Institute of Technology, Old Westbury, NY
| | - Amir H Sohail
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Helen Liu
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - David Halpern
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
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20
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Pallan A, Dedelaite M, Mirajkar N, Newman PA, Plowright J, Ashraf S. Postoperative complications of colorectal cancer. Clin Radiol 2021; 76:896-907. [PMID: 34281707 DOI: 10.1016/j.crad.2021.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
Colorectal cancer is the third most common cancer, and surgery is the most common treatment. Several surgical options are available, but each is associated with a range of potential complications. The timely and efficient identification of these complications is vital for effective clinical management of these patients in order to minimise their morbidity and mortality. This review aims to describe the range of commonly performed surgical treatments for colorectal surgery. In addition, frequent post-surgical complications are explored with investigative options explained and illustrated.
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Affiliation(s)
- A Pallan
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - M Dedelaite
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - N Mirajkar
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P A Newman
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - J Plowright
- Department of Radiology, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - S Ashraf
- Department of Colorectal Surgery, University Hospitals Birmingham NHS FT, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
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21
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Zachariah SK, P AK, Jayadas R, Devi M. Obstructed Left Paraduodenal Hernia: A Rare Cause of Acute Abdomen in a COVID-19 Patient. Cureus 2021; 13:e16265. [PMID: 34377603 PMCID: PMC8349224 DOI: 10.7759/cureus.16265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/05/2022] Open
Abstract
A paraduodenal hernia (PDH) is a rare type of internal hernia, which results from anomalous rotation and reduction of the midgut loop in the embryo. The diagnosis is often difficult due to nonspecific symptoms. The mortality from an acute internal hernia can be close to 50% when the diagnosis and definitive surgical treatment are delayed. Here we present a rare case of obstructed left paraduodenal hernia (LPDH) in a COVID-positive patient. This is probably the earliest report of acute mechanical intestinal obstruction due to LPDH in a COVID-positive patient.
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Affiliation(s)
- Sanoop K Zachariah
- General and Minimal Access Surgery, Kerala Institute of Medical Sciences-KIMSHEALTH, Trivandrum, IND
| | - Anil K P
- General and Minimal Access Surgery, Kerala Institute of Medical Sciences-KIMSHEALTH, Trivandrum, IND
| | - Reji Jayadas
- General and Minimal Access Surgery, Kerala Institute of Medical Sciences-KIMSHEALTH, Trivandrum, IND
| | - Maya Devi
- General and Minimal Access Surgery, Kerala Institute of Medical Sciences-KIMSHEALTH, Trivandrum, IND
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22
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Raj Kumar N, Tajudeen M. Strangulated Falciform Hernia. Cureus 2021; 13:e15898. [PMID: 34322344 PMCID: PMC8310387 DOI: 10.7759/cureus.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/05/2022] Open
Abstract
Internal hernias are rare, and a delayed diagnosis can lead to dangerous complications. A 75-year-old male with no previous surgical history presented with right upper abdominal pain and vomiting. On examination, he had guarding in the right hypochondrium with a positive Murphy's sign. However, ultrasonography of the gall bladder was normal with dilated bowel loops. Contrast-enhanced CT (CECT) revealed a falciform hernia with evidence of obstruction. Segmental resection of the gangrenous ileum was done with a double-barrel stoma. Later on, stoma reversal was also done with no complications.
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Affiliation(s)
- Nagarajan Raj Kumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Muhamed Tajudeen
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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23
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Kelahan L, Menias CO, Chow L. A review of internal hernias related to congenital peritoneal fossae and apertures. Abdom Radiol (NY) 2021; 46:1825-1836. [PMID: 33128101 DOI: 10.1007/s00261-020-02829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023]
Abstract
Congenital-type internal hernias have the potential to cause small bowel obstruction well into adulthood. Congenital-type internal hernias include left paraduodenal, right paraduodenal, foramen of Winslow, pericecal, sigmoid mesocolon, transomental, small bowel mesentery, and broad ligament hernias. This review summarizes CT imaging features and complications of congenital internal hernias using a systematic approach based on abdominopelvic quadrants and key anatomic features. CT imaging will continue to be commonly used to evaluate abdominal pain. Anatomical landmarks and characteristic CT findings can help identify congenital internal hernias as a potential cause of abdominal pain.
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Affiliation(s)
- Linda Kelahan
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Lawrence Chow
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
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24
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The beak sign of foramen of Winslow hernia. Abdom Radiol (NY) 2021; 46:2261-2262. [PMID: 33247767 DOI: 10.1007/s00261-020-02878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
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25
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Udo IA, Obong V. Left Paraduodenal Hernia: A Cause of Double Intestinal Obstruction. Niger J Surg 2021; 27:78-80. [PMID: 34012249 PMCID: PMC8112357 DOI: 10.4103/njs.njs_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022] Open
Abstract
Paraduodenal hernias are of congenital origin and may present with symptoms and signs of small intestinal obstruction. These hernias are rare in our practice, and a definitive preoperative diagnosis is often not made as the symptoms are not specific. Early assessment and prompt and adequate resuscitation and surgery obviate the risk of strangulation and intestinal resection. This report highlights a rare cause of intestinal obstruction in a young male who presents with all the classical features of obstruction: colicky abdominal pain, distension, vomiting, and inability to pass stool or flatus. The diagnosis of paraduodenal hernia was made intraoperatively. We do not routinely request for barium examination or abdominal computed tomography scan in acute abdominal pain. These modalities can suggest a preoperative diagnosis.
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Affiliation(s)
- Isaac Assam Udo
- Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Victor Obong
- Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria
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26
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Gonzalez-Urquijo M, Zambrano-Lara M, Patiño-Gallegos JA, Rodarte-Shade M, Leyva-Alvizo A, Rojas-Mendez J. Pregnant patients with internal hernia after gastric bypass: a single-center experience. Surg Obes Relat Dis 2021; 17:1344-1348. [PMID: 33858785 DOI: 10.1016/j.soard.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bariatric surgery has been a popular way for many women to reach a healthy body mass index, and as a consequence, a decreased body mass, which causes a greater chance of fertility, with improved pregnancy and better maternal outcomes. OBJECTIVE Describe a single-center experience of pregnancies complicated by internal hernias after gastric bypass. SETTING Academic Medical Center. METHODS During 2011 and 2019 a series of patients were treated for internal hernia after gastric bypass at our teaching hospital. The hospital records were retrospectively reviewed. RESULTS Seven women were treated. Median age was 33 years (range: 24-39 yr). Median gestational age was 25.6 weeks (range: 5-33 wk). Median time from Roux-en-Y gastric bypass to pregnancy was 4 years (range: 1-7 yr). Median body mass index was 24 kg/m2 (range: 24-31 kg/m2). Five (71.4%) patients underwent an exploratory laparotomy, and 2 (28.5%) patients a diagnostic laparoscopy. In all patients, an internal hernia of the small bowel in the Petersen space was encountered. Median length of pregnancy was 38 weeks (range: 33.6-39.6 wk). Six (85.7%) patients underwent C-section, and 1 (14.2%) patient gave birth by vaginal delivery. There was only 1 maternal postoperative complication and no fetal postoperative complications. Median follow-up was 9 months (range: 2-20 mo). CONCLUSION The rapid growth in bariatric surgery on obese women of fertile age could result in more cases of internal herniation during pregnancy in the future. An internal hernia should be suspected when encountering a postgastric bypass pregnant patient with abdominal pain, nausea, and vomiting.
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Affiliation(s)
| | - Mario Zambrano-Lara
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | | | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | - Adolfo Leyva-Alvizo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | - Javier Rojas-Mendez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México.
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27
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Brammerloo YGA, Vannijvel M, Devriendt S, Verhaak T, Ultee G, Göttgens KWA, Langenhoff BS. Internal Hernia After Laparoscopic Gastric Bypass Without Preventive Closure of Mesenteric Defects: a Single Institution's Experience. J Gastrointest Surg 2021; 25:623-634. [PMID: 32767016 DOI: 10.1007/s11605-020-04761-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internal herniation (IH) is a well-known complication after laparoscopic gastric bypass (LGB). Diagnosing and managing IH can be challenging. This retrospective cohort study aimed to achieve a greater understanding of symptomatology, diagnostic tools, complications, risk of IH recurrence, and symptom relief in IH patients. METHODS We included patients who underwent LGB surgery at our institution between 2011 and 2015. Mesenteric defects were not preventively closed during LGB. We focused on LGB patients who underwent surgical intervention(s) for suspected IH during a 7-year study period. We studied patient characteristics, (predictive) symptoms and signs, abdominal imaging, operative findings, post-operative course, and risk of (recurrent) IH. RESULTS A total of 1588 patients were included. In total, 243 patients underwent IH-related diagnostic laparoscopy. Radiating pain to the back (OR 2.45, p = .03), post-prandial pain (OR 3.23, p = .00), and leukocytosis (OR 15.53, p = .01) were identified as predictors of IH. The estimated risk of IH-related diagnostic laparoscopy was 16% at 3 years post-LGB, and the risk of confirmed IH was 12%. The estimated risk of diagnostic laparoscopy for suspected recurrent IH was 10% at 5 years post-LGB. In patients who underwent secondary mesenteric defects closure, post-operative symptom relief was reported in 84%. CONCLUSION This study demonstrates a considerable risk of developing IH after LGB without preventive closure of the mesenteric defects. We emphasize the value of diagnostic laparoscopy to achieve symptom relief in patients with suspicion of IH. Preoperative diagnosis of IH can be improved by being watchful of specific symptoms and signs which can predict the intra-operative presence of IH.
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Affiliation(s)
- Y G A Brammerloo
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands.
| | - M Vannijvel
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - S Devriendt
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - T Verhaak
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - G Ultee
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - K W A Göttgens
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - B S Langenhoff
- Department of Gastro-intestinal Surgery, Elisabeth-TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
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28
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Trieu Trieu D, Van Le Q, Van Nguyen H. Open Surgery Treatment of a Rare Cause of Intestinal Obstruction: Left Paradoudenal Hernia. Int Med Case Rep J 2021; 14:11-14. [PMID: 33531845 PMCID: PMC7846872 DOI: 10.2147/imcrj.s295622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022] Open
Abstract
An internal hernia is the protrusion of visceral contents through a congenital or acquired defect in the peritoneum or mesentery within the abdominal cavity. In approximately 0.6–5.8% of patients with small intestinal obstruction, the cause is internal hernia, with paraduodenal hernias accounting for approximately 40% of cases. Here, we present the case of a 51-year-old man diagnosed with obstruction of the small intestine caused by a hernia on the left side of the duodenum. The treatment involved returning the bowel loops to the normal position and closing the hernia pocket using Prolene 2.0 sutures. The duration of the surgery was 30 min. Five days later, the patient’s condition was stable and he was discharged from the hospital; at the 32-month postoperative follow-up, he remained in stable condition with no recurrence. An abdominal computed tomography scan is valuable for early diagnosis of paraduodenal hernia in the absence of complications, and the cause can be identified and the bowel returned to the normal position by endoscopic surgery, with closure of the hernia pocket if the intestine does not stick to the pocket.
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Affiliation(s)
- Duong Trieu Trieu
- Department of Colon and Rectal Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Quoc Van Le
- Department of Colon and Rectal Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Hien Van Nguyen
- Department of Colon and Rectal Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
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29
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Jain A, Vishnoi JR, Sasidhar A, Pareek P, Misra S. Ileocolocolic intussusception with multiple internal abdominal herniations complicated by multiple colonic perforations: an enigma. ANZ J Surg 2020; 91:E528-E530. [PMID: 33368931 DOI: 10.1111/ans.16530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Ankit Jain
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Jeewan Ram Vishnoi
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ajai Sasidhar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Puneet Pareek
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
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30
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Maheshwari S, Khadka A, Bhattacharjee S, Rajesh U, Maria V. A case report of left paraduodenal hernia with a spontaneous reduction on follow-up: the rare demonstration on computed tomography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00338-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Left paraduodenal hernia (PDH) makes for around 40% of all internal hernias. It is due to the prolapse of bowel through fossa of Landzert, an anatomic variant that is found in around 2% of the population. This hernia is presumed to be spontaneously reducible in many patients with recurrent symptoms.
Case presentation
The present report shows the case of this condition in a 65-year-old male presenting with recurrent abdominal pain and subacute intestinal obstruction who was unwilling for surgery and was managed conservatively. A follow-up scan after 11 months revealed complete spontaneous resolution of hernia.
Conclusions
This represents only the second demonstration of the oft-mentioned spontaneous reduction of this condition on computed tomography. The radiologists should be aware of this uncommon entity and in the event of clinical suspicion; the imaging should be performed when the patient is symptomatic.
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31
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Mohamed AAA, Al Shuraiqi FM, Al Sarhani S, Al Busaidi SAS, Joodi AA. Congenital peritoneal encapsulation presented with small bowel obstruction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00287-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
Congenital peritoneal encapsulation is an extremely rare condition with an etiology based on abnormal embryonic gastrointestinal development. It is characterized by congenital development of an accessory peritoneal layer partially or entirely encapsulating the small bowel. The condition is poorly understood and often discovered incidentally, either intra-operatively or during autopsy. The majority of cases are asymptomatic and rarely complicated by small bowel obstruction. The preoperative diagnosis may be impossible by plain radiographs, which are often normal or may show signs of small bowel obstruction. Computed tomography (CT) may be helpful in preoperative diagnosis of congenital peritoneal encapsulation in a patient with obstruction.
Case presentation
We report a case of a 46-year-old male patient, who presented with features of intestinal obstruction; surprisingly, CT accurately suggested the diagnosis of peritoneal encapsulation which was confirmed at surgery.
Conclusions
The presence of physical signs such as asymmetrical and fixed abdominal distension can help the clinician to raise the suspicion of peritoneal encapsulation; however, CT in the right settings can confirm the diagnosis.
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Alghamdi F, Alharbi A, Alshamrani A, Alomani S. Paracecal hernia with intestinal obstruction managed with laparoscopic surgery: A case report. Int J Surg Case Rep 2020; 77:329-332. [PMID: 33197779 PMCID: PMC7677657 DOI: 10.1016/j.ijscr.2020.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/25/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022] Open
Abstract
Paracecal hernia is a rare cause of intestinal obstruction. Computed tomography can help in early diagnosis and avoidance of strangulation. Laparoscopic surgery is a feasible alternative to open surgery for these cases.
Introduction Paracecal hernia is a rare cause of intestinal obstruction. Presentation of case A 75-year-old man presented with abdominal pain for 4 days, vomiting, and obstipation. Physical examination was not conclusive. Abdominal radiograph suggested small intestinal obstruction, and computed tomography confirmed an obstructed paracecal hernia. Intraoperatively, the hernial sac was seen passing through the inferior ileocecal recess. The distal bowel was collapsed. The appendix was inflamed. The hernia was reduced and appendectomy was performed. The patient recovered without complications and was discharged on the fifth postoperative day. Discussion Internal hernia may be a cause of acute abdomen. Symptoms and signs may be nonspecific. Rapid recognition of the condition can prevent strangulation and ischemia of affected intestinal loops. Early resort to imaging examination will ensure quick diagnosis. Conclusion Paracecal hernia is a rare cause of intestinal obstruction. Awareness of the imaging features will help avoid delay in diagnosis. Laparoscopic surgery appears to be a safe and feasible treatment.
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Affiliation(s)
- Faisal Alghamdi
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ashwag Alharbi
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Abdullah Alshamrani
- Department of General Surgery, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Saud Alomani
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Robinson K, Hersey S, Narula N. Small Bowel Sigmoid Colon Fistula Resulting from Diverticulitis Causing an Internal Hernia. J Gastrointest Surg 2020; 24:2688-2689. [PMID: 32323254 DOI: 10.1007/s11605-020-04605-7] [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: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Kortney Robinson
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sean Hersey
- Division of Acute Care Surgery, Trauma, Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nisha Narula
- Division of Acute Care Surgery and Trauma, Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 2, Boston, MA, 02215, USA.
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Gopalan S, Raghu V. Unravelling the Mysteries of the Mesentery. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1718247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractThe mesentery and its folds tether the small bowel loops to the posterior abdominal wall. It transmits nerves, vessels, and lymph ensconced in a fatty sponge layer wrapped in a thin glistening peritoneum, from and to the small bowel. Not only does this flexible dynamic fatty apron house various localized primary benign and malignant lesions, it is often involved in and gives an indication of generalized or systemic diseases in the body. An understanding of the anatomy, components, and function of the mesentery helps to classify mesenteric abnormalities. This further allows for characterizing radiological patterns and appearances specific to certain disease entities. Recent reviews of mesenteric anatomy have kindled new interest in its function and clinical applications, heralding the possibility of revision of its role in diseases of the abdomen.
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Affiliation(s)
- Sunita Gopalan
- Department of Radiology, Columbia Asia Radiology Group, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
| | - Vineetha Raghu
- Department of Radiology, Columbia Asia Radiology Group, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
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Francis KC, Daley C, Williams BPR, Bullock R, Singh U, Baker A. The "Omega sign": a new radiological sign for a rare type of internal hernia involving the sigmoid mesocolon. BJR Case Rep 2020; 6:20190127. [PMID: 33029380 PMCID: PMC7527005 DOI: 10.1259/bjrcr.20190127] [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: 11/24/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 11/17/2022] Open
Abstract
The transmesosigmoid hernia is a rare type of sigmoid mesocolon hernia. Its presentation is non-specific and thus hardly ever preoperatively diagnosed. Its diagnosis often requires surgical corroboration. This case report aims to improve on the preoperative diagnosis with a proposed observed sign on CT. All literature reviewed described radiological findings related to the small bowel; thus, features of small bowel obstruction was the “hallmark” of internal hernias. This paper intends to describe the features of the sigmoid mesocolon internal hernias, illustrate and propose a never reported configuration of the sigmoid colon. This sigmoid colon configuration has a resemblance to the omega sign. We intend to present a new hallmark sign, which may serve as a clue in the identification of internal hernias involving the sigmoid mesocolon.
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Affiliation(s)
- Kino Ceon Francis
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Candice Daley
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Bonnie-Paul Regis Williams
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Richard Bullock
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Ulanda Singh
- Department of Surgery, University Hospital of the West Indies, Mona, Jamaica
| | - Akil Baker
- Department of Surgery, University Hospital of the West Indies, Mona, Jamaica
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36
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Raspante LBDP, Barquette ÁDC, Motta EGPC, Ribeiro MA, Ramos LFM, Moreira W. Review and pictorial essay on complications of bariatric surgery. ACTA ACUST UNITED AC 2020; 66:1289-1295. [PMID: 33027460 DOI: 10.1590/1806-9282.66.9.1289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/22/2020] [Indexed: 11/21/2022]
Abstract
Obesity is a chronic disease characterized by excess fat in the body and a real public health problem. Bariatric surgery, in recent decades, has gained space in its treatment due to the efficiency obtained in weight loss and significant reduction of the related comorbidities. The most commonly performed bariatric procedures include Roux-en-Y gastric bypass, adjustable gastric band, and laparoscopic sleeve gastrectomy. Possible complications described include fistulas, dehiscence, marginal ulcers, intestinal obstruction, internal hernias, and anastomotic stenosis. These complications may have unfavorable clinical outcomes since symptoms are often nonspecific. Abdominal computed tomography (CT) is an important tool in the evaluation of postoperative complications, both in the immediate and late postoperative status of patients undergoing such a procedure. We analyzed the most illustrative tomographic findings of the different complications after reducing gastroplasty in 203 patients without distinction of age or gender. Correct interpretation requires radiologists to understand the surgical technique since postoperative anatomy and surgery-specific complications may be obstacles to proper interpretation.
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Affiliation(s)
- Laio Bastos de Paiva Raspante
- Médico com Pós-Graduação em Radiologia e Diagnóstico por Imagem - Ciências Médicas de Minas Gerais (PGCM-MG) - Fundação Educacional Lucas Machado (Feluma), Belo Horizonte, MG, Brasil
| | - Ávanny do Carmo Barquette
- Médico com Pós-Graduação em Radiologia e Diagnóstico por Imagem - Ciências Médicas de Minas Gerais (PGCM-MG) - Fundação Educacional Lucas Machado (Feluma), Belo Horizonte, MG, Brasil
| | | | | | | | - Wanderval Moreira
- Médico Radiologista da Rede MaterDei de Saúde - Radiologia, Belo Horizonte, MG, Brasil
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37
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Chatterjee A, Ramanan RV, Mukhopadhyay S. Imaging Postoperative Abdominal Hernias: A Review with a Clinical Perspective. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1715772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractPostoperative internal hernia is a challenging but critical diagnosis in postoperative patients presenting with acute abdomen. Postoperative internal hernias are increasingly being recognized after Roux-en-Y gastric bypass (RYGB) and bariatric surgeries. These internal hernias have a high risk of closed-loop obstruction and bowel ischemia; therefore, prompt recognition is necessary. Computed tomography (CT) is the imaging modality of choice in cases of postoperative acute abdomen. Understanding the types of postoperative internal hernia and their common imaging features on CT is crucial for the abdominal radiologist. Postoperative external hernias are usually a result of defect or weakness of the abdominal wall created because of the surgery. CT helps in the detection, delineation, diagnosis of complications, and surgical planning of an external hernia. In this article, the anatomy, pathophysiology, and CT features of common postoperative hernias are discussed. Afterreading this review, the readers should be able to (1) enumerate the common postoperative internal and external abdominal hernias, (2) explain the pathophysiology and surgical anatomy of Roux-en-Y gastric bypass-related hernia, (3) identify the common imaging features of postoperative hernia, and (4) diagnose the complications of postoperative hernias.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Sumit Mukhopadhyay
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
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38
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Shin CI, Kim SH. Normal and Abnormal Postoperative Imaging Findings after Gastric Oncologic and Bariatric Surgery. Korean J Radiol 2020; 21:793-811. [PMID: 32524781 PMCID: PMC7289697 DOI: 10.3348/kjr.2019.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/10/2020] [Accepted: 02/11/2020] [Indexed: 11/15/2022] Open
Abstract
Surgical resection remains the primary choice of treatment and the only potentially curative option for gastric carcinoma, and is increasingly performed laparoscopically. Gastric resection represents a challenging procedure, with a significant morbidity and non-negligible postoperative mortality. The interpretation of imaging after gastric surgery can be challenging due to significant modifications of the normal anatomy. After the surgery, the familiarity with expected imaging appearances is crucial for diagnosis and appropriate management of potentially life-threatening complications in patients who underwent gastric surgery. We review various surgical techniques used in gastric surgery and describe fluoroscopic and cross-sectional imaging appearances of normal postoperative anatomic changes as well as early and late complications after gastric surgery.
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Affiliation(s)
- Cheong Il Shin
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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39
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Junttila A, Virtanen J, Mrena J, Mattila AK. Laparoscopic treatment of small bowel strangulation caused by an intramesosigmoid hernia and review of literature. BMJ Case Rep 2020; 13:13/4/e233627. [PMID: 32354762 DOI: 10.1136/bcr-2019-233627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An internal hernia is defined as a protrusion of an abdominal viscera through the defects of the gastrointestinal mesentery or peritoneum-lined fossa. Sigmoid mesocolic hernias are an uncommon type of internal hernias, accounting for only 6% of all internal hernias. Furthermore, intramesosigmoid hernia is one of the three subtypes of the sigmoid mesocolic hernias. Internal hernias are potentially fatal conditions with diagnostic challenges. Patients presenting with acute obstruction, no surgical history and no external hernia should receive an urgent CT scan to facilitate early surgery and to minimise the risk of strangulation and bowel resection. Here, we report a case of strangulated small bowel obstruction secondary to an intramesosigmoid hernia with a successful laparoscopic repair. We also present a literature review of all reported cases so far and give an up-to-date perspective on intramesosigmoid hernia.
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Affiliation(s)
- Anna Junttila
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Juha Virtanen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Johanna Mrena
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Anne K Mattila
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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Abstract
The underlying etiologies of paediatric bowel obstruction are wide ranging. It can be divided into proximal and distal bowel obstruction. Amongst the different etiologies of the proximal bowel obstructions at the level of the duodenum, there are a few etiologies including duodenal atresia, internal hernias, intestinal malrotation, annular pancreas etc. Superior mesenteric artery syndrome is amongst one of these differential diagnoses which is more prevalent in the adolescent age group. We describe the imaging features of this entity and its demographics, imaging characteristics, treatment and prognosis.
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Affiliation(s)
- Perry Liew Jia Ren
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore
| | - Achint Gupta
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore
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41
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Gosavi R, Ban E. A rare case of a closed loop obstruction due to epiploic appendage of the sigmoid colon. J Surg Case Rep 2020; 2020:rjaa008. [PMID: 32153757 PMCID: PMC7054199 DOI: 10.1093/jscr/rjaa008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
An internal hernia is a protrusion of viscera through a congenital or acquired defect in the mesentery of peritoneum. They account for <0.9% of all small bowel obstructions [1] and ~4% of obstructions due to hernias [2]. We present a rare case of closed loop obstruction secondary to a band adhesion traversing the lower abdomen from a sigmoid colon appendage epiploicae to the right pelvic wall. A 82-year-old woman presented to the emergency department with nausea, vomiting and worsening right sided abdominal pain for 24 h, on the background of previous pelvic radiation and hysterectomy for uterine cancer. She was subsequently found to have a closed loop obstruction with 30 cm of ischemic bowel strangulated by a band adhesion from a sigmoid colon appendage epiploicae to the right abdominal wall. The patient underwent a successful small bowel resection with primary anastomosis and made an uneventful recovery.
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Affiliation(s)
- Rathin Gosavi
- Department of Breast and Endocrine Surgery, Alfred Health, Melbourne, Victoria 3195, Australia
| | - Ee Ban
- Department of Breast and Endocrine Surgery, Alfred Health, Melbourne, Victoria 3195, Australia
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42
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Identification and Repair of Left-Sided Paraduodenal Hernia Using Both Laparoscopic and Robotic Techniques. Case Rep Surg 2020; 2020:7569530. [PMID: 32089943 PMCID: PMC7025034 DOI: 10.1155/2020/7569530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/07/2019] [Indexed: 12/18/2022] Open
Abstract
Internal hernias are an uncommon cause of small bowel obstruction and present a challenging clinical diagnostic scenario. They result from the abnormal protrusion of an abdominal organ through a peritoneal defect and can cause intermittent obstructive symptoms, diffuse abdominal discomfort, and postprandial pain. Paraduodenal hernias comprise 53% of all internal hernias 1 and occur due to failure of the fixation of either the left or transverse mesocolon to the posterior abdominal wall. Its relative rarity results in mortality between 20 and 50% 2 because of delayed diagnosis and consequent obstruction, strangulation, and bowel ischemia. Our case series describes three patients before and after operative fixation of paraduodenal hernia. Only one of the three was identified by preoperative radiologist interpretation. Subsequent diagnosis and definitive treatment were completed by surgical staff to resolve undiagnosed undulating abdominal pain and obstructive-type symptoms. We further analyze left-sided paraduodenal hernias after laparoscopic and robotic repair to define common symptomatology, typical CT findings, and preferred laparoscopic repair techniques.
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43
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Zhang F, Qiao Y, Zhang H. Multidetector Computed Tomography Findings of Adhesive Internal Hernias. J Comput Assist Tomogr 2020; 44:131-137. [PMID: 31939894 DOI: 10.1097/rct.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify multidetector computed tomography (MDCT) findings of surgically confirmed adhesive internal hernias (IHs). METHODS Two gastrointestinal radiologists performed blinded, independent, and retrospective reviews of MDCT findings from a consecutive cohort of 35 adhesive IH and 41 adhesive small-bowel obstruction cases that had undergone surgery within 48 hours after MDCT. Univariate statistical analyses were performed to assess CT signs of adhesive IHs and CT findings of intestinal necrosis in patients presenting with adhesive IHs. RESULTS Dislocated cluster of the intestine (P = 0.005), 2 transitional zones (P = 0.002), and presence of fat in the center sign (P = 0.001) were key CT outcomes that were significantly associated with adhesive IHs. Additionally, intramural hemorrhage was found the MDCT feature indicative of intestinal necrosis (P = 0.028). CONCLUSIONS This study illustrates specific MDCT findings of IHs, and these observations may help guide early clinical management of the condition.
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Affiliation(s)
- Fengyan Zhang
- From the Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
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44
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Abstract
We present a case-based review of abdominal postoperative complications, organized by organ system affected, including wound/superficial, hepatobiliary, pancreatic, gastrointestinal, genitourinary, and vascular complications. Both general complications and specific considerations for certain types of operations are described, as well as potential pitfalls that can be confused with complications. Representative cases are shown using all relevant imaging modalities, including CT, fluoroscopy, ultrasound, MRI, and nuclear medicine. Management options are also described, highlighting those that require radiologist input or intervention.
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Affiliation(s)
- Ryan B O'Malley
- Department of Radiology, Abdominal Imaging, University of Washington, 1959 Northeast Pacific Street, Box 357115, Seattle, WA 98195, USA.
| | - Jonathan W Revels
- Department of Radiology, Body and Thoracic Imaging, University of New Mexico, Albuquerque, NM, USA
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45
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Al Otaibi RS, Al Maghrabi HS, Bin Dous Y, Malaekah H. A Rare Case of Small Bowel Obstruction Due to Paraduodenal Hernia. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1581-1586. [PMID: 31656310 PMCID: PMC6839541 DOI: 10.12659/ajcr.918403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patient: Female, 24 Final Diagnosis: Paraduodenal hernia Symptoms: Abdominal pain • Bowel obstruction Medication: — Clinical Procedure: Surgical excision of the sac and release of adhesion Specialty: Surgery
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Affiliation(s)
- Rahaf Suhail Al Otaibi
- Surgical Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Huda S Al Maghrabi
- Surgical Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yazeed Bin Dous
- Department of Medical Imaging, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Haifaa Malaekah
- Surgical Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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46
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Klop C, Deden LN, Aarts EO, Janssen IMC, Pijl MEJ, van den Ende A, Witteman BPL, de Jong GM, Aufenacker TJ, Slump CH, Berends FJ. Diagnosing Internal Herniation After Roux-en-Y Gastric Bypass Surgery: Literature Overview, Cadaver Study and the Added Value of 3D CT Angiography. Obes Surg 2019; 28:1822-1830. [PMID: 29404939 PMCID: PMC6107799 DOI: 10.1007/s11695-018-3121-3] [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] [Indexed: 11/23/2022]
Abstract
Purpose The purposes of the study are to outline the complexity of diagnosing internal herniation after Roux-en-Y gastric bypass (RYGB) surgery and to investigate the added value of computed tomography angiography (CTA) for diagnosing internal herniation. Materials and Methods A cadaver study was performed to investigate the manifestations of internal hernias and mesenteric vascularization. Furthermore, a prospective, ethics approved study with retrospective interpretation was conducted. Ten patients, clinically suspected for internal herniation, were prospectively included. After informed consent was obtained, these subjects underwent abdominal CT examination, including additional arterial phase CTA. All subjects underwent diagnostic laparoscopy for suspected internal herniation. The CTA was used to create a 3D reconstruction of the mesenteric arteries and surgical staples (3D CTA). The 3D CTA was interpreted, taking into account the presence and type of internal hernia that was found upon laparoscopy. Results Cadaveric analysis demonstrated the complexity of internal herniation. It also confirmed the expected changes in vascular structure and surgical staple arrangement in the presence of internal herniation. 3D CTA studies of the subjects with active internal hernias demonstrated remarkable differences when compared to control 3D CTA studies. The blood supply of herniated intestinal limbs in particular showed abnormal trajectories. Additionally, enteroenterostomy staple lines had migrated or altered orientation. Conclusion 3D CTA is a promising technique for diagnosing active internal hernias. Our findings suggest that for diagnosing internal hernias, focus should probably shift from routine abdominal CT examination towards the 3D assessment of the mesenteric vasculature and surgical staples. Electronic supplementary material The online version of this article (10.1007/s11695-018-3121-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cornelis Klop
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. .,Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
| | - Laura N Deden
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Edo O Aarts
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Ignace M C Janssen
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Milan E J Pijl
- Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Bart P L Witteman
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Gabie M de Jong
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Theo J Aufenacker
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Frits J Berends
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
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47
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Inoue A, Furukawa A. Computed tomography diagnosis of transomental hernia. Jpn J Radiol 2019; 37:860-861. [PMID: 31542855 DOI: 10.1007/s11604-019-00879-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, Higashioku, 7-2-10, Arakawa-ku, Tokyo, Japan
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Yoshida N, Fujita F, Ueda K, Ogata S, Shigaki T, Yomoda T, Ohchi T, Mizobe T, Kinugasa T, Akagi Y. Mesocolic hernia following retroperitoneal laparoscopic radical nephrectomy: A case report. Int J Surg Case Rep 2019; 61:313-317. [PMID: 31399395 PMCID: PMC6717955 DOI: 10.1016/j.ijscr.2019.07.040] [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: 06/24/2019] [Accepted: 07/17/2019] [Indexed: 11/18/2022] Open
Abstract
An internal hernia after retroperitoneal laparoscopic nephrectomy is rare. Retroperitoneal approach has the risk of making mesocolic defects directly. To prevent internal hernia, we should close the mesenteric defects intraoperatively.
Introduction Small bowel obstruction (SBO) caused by an internal hernia through a mesocolon after retroperitoneal laparoscopic nephrectomy (RLN) is rare. Presentation of case A 66-year-old man who had undergone RLN with bladder cuff excision for a left renal pelvic cancer. After the surgery, he experienced SBO repeatedly. Contrast-enhanced computed tomography (CT) and gastrografin contract radiography through a long tube showed an internal hernia through the mesocolon to the retroperitoneal space where the resected left kidney had been located. We performed a subsequent surgery for the internal hernia. Postoperative course was uneventful and currently he has no recurrence of herniation 6 months post-operatively. Discussion Mesenteric defects that cause an internal hernia can be created inadvertently during RLN when the colon is mobilized medially, and the kidney is being detached from retroperitoneum. The removal of a kidney leads to a potential retroperitoneal space to which small intestine can migrate. While there is no absolute necessity in mobilizing the colon during the retroperitoneal laparoscopic approach, there is still a risk of making mesocolic defects directly in the retroperitoneal space. Conclusion We need to perform operations with sufficient anatomical knowledge of retroperitoneal fascia and careful surgical techniques. The critical thing to prevent an internal hernia following RLN is to close the mesenteric defects intraoperatively. It is also important to suspect an internal hernia and do proper examinations promptly when patients had the symptoms of SBO after nephrectomy.
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Affiliation(s)
- Naohiro Yoshida
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Suguru Ogata
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Takahiro Shigaki
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Takato Yomoda
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Takafumi Ohchi
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Tomoaki Mizobe
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Tetsushi Kinugasa
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan.
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49
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Mazzetti CH, Hock N, Taylor S, Lemaitre J, Crener K, Lebrun E. Acute abdominal pain due to internal herniation of the sigmoid colon, fallopian tube and left ovary, a rare presentation of Allen Masters syndrome. Acta Chir Belg 2019; 119:248-250. [PMID: 29433380 DOI: 10.1080/00015458.2018.1438558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In 1955, Allen and Masters describe a painful syndrome which associates traumatic delivery to laceration found on the posterior leaf of the broad ligament. Herniation through this defect is a rare entity, accounted for about 4-7% of all internal hernias. Normally, it involves the small bowel. The authors present the case of a multiparous woman admitted at emergency for constipation and abdominal pain. The CT scan showed an extremely rare case of internal hernia of the sigmoid colon, fallopian tube and left ovary through a large defect of the broad ligament. The patient underwent a full laparoscopic surgery that allowed the reduction of the hernia and the suture of the defect with very good outcome.
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Affiliation(s)
- C. H. Mazzetti
- Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | - N. Hock
- Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | - S. Taylor
- Department of Radiology, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | - J. Lemaitre
- Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | - K. Crener
- Department of Gynecology, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | - E. Lebrun
- Department of Visceral Surgery, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
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Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg 2019; 14:20. [PMID: 31168315 PMCID: PMC6489175 DOI: 10.1186/s13017-019-0240-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Small and large bowel obstructions are responsible for approximately 15% of hospital admissions for acute abdominal pain in the USA and ~ 20% of cases needing acute surgical care. Starting from the analysis of a common clinical problem, we want to guide primary care physicians in the initial management of a patient presenting with acute abdominal pain associated with intestinal obstruction.
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Affiliation(s)
- Fausto Catena
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Belinda De Simone
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | | | | | | | - Luca Ansaloni
- Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy
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