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Nesiama EA, Quigley L, Nazim H, Prakash S, Obokhare I. Laparoscopic Repair of Small Bowel Obstruction Caused by an Intersigmoid Hernia: A Case Report. Cureus 2023; 15:e36793. [PMID: 37123668 PMCID: PMC10134408 DOI: 10.7759/cureus.36793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
Bowel obstructions can be caused by internal hernias which are protrusions of the bowel into openings within the abdominal cavity. There are various types of internal hernias including sigmoid hernias which involve the sigmoid mesentery.Sigmoid hernias are very difficult to diagnose clinically, even with the aid of radiologic imaging. Computed tomography (CT) scan findings often reveal small bowel obstructions; however, they are not sensitive to intersigmoid hernias. Most of these rare herniations are repaired by open abdominal surgery followed by the closure of the mesenteric defect to prevent a recurrence. We present the case of a 57-year-old man who presented to the emergency department with a small bowel obstruction that was caused by an intersigmoid hernia and was successfully repaired through a minimally invasive laparoscopic approach. This case demonstrates an intra-operative diagnosis of an intersigmoid hernia and reviews the benefits of a laparoscopic approach for the reduction of the sigmoid mesentery.
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Sawano T, Kurokawa T, Ozaki A, Bhandari D, Furuya M, Kanemoto Y, Tsubokura M, Ejiri T, Kanzaki N. Strangulated transomental hernia in virgin abdomen: laparoscopic surgery with a small laparotomy may be useful to assess the indeterminate viability of the bowel. J Surg Case Rep 2022; 2022:rjac374. [PMID: 36003222 PMCID: PMC9393190 DOI: 10.1093/jscr/rjac374] [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: 04/24/2022] [Accepted: 07/27/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
A 66-year-old female without prior history of abdominal surgery visited the emergency department with a complain of sudden intensive lower abdominal pain. Closed loop bowel obstruction was discovered on contrast-enhanced computed tomography, leading to a laparoscopic examination of 5 h after the onset. During laparoscopy, 100 cm of distal jejunum with borderline viability was found incarcerated in a gap of the greater omentum. A 3-cm small incision was made at the umbilical trocar site to observe the bowel after it was released laparoscopically. When viewed under the shadowless lamp, the affected bowel appeared reddish, with peristalsis and a palpated mesentery artery. The surgical team determined no need for resection. The postoperative recovery went smoothly without any complications. Laparoscopic surgery for transomental hernias can be performed safely even in patients with borderline bowel viability, and observing bowel extra-peritoneally with a small incision could be helpful for laparoscopic surgery for internal hernias with borderline viability.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima , Japan
- Department of Radiation Health Management, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Tomohiro Kurokawa
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima , Japan
- Department of Medical Epigenomics Research, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima , Japan
| | - Divya Bhandari
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima , Japan
| | - Mioko Furuya
- Department of Surgery, Itabashi Chuo Medical Center , Tokyo , Japan
| | - Yoshiaki Kanemoto
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima , Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Tomozo Ejiri
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima , Japan
| | - Norio Kanzaki
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation , Iwaki, Fukushima , Japan
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Kambe H, Kitamura K, Kaihara S. A case report of intersigmoid hernia treated using laparoscopic surgery. Int J Surg Case Rep 2021; 81:105822. [PMID: 33887854 PMCID: PMC8049999 DOI: 10.1016/j.ijscr.2021.105822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Intersigmoid hernia (ISH) is a rare disease that is difficult to diagnose preoperatively and sometimes causes intestinal necrosis that requires emergency surgery. CASE PRESENTATION The patient was an 87-year-old male with no history of abdominal surgery who visited our emergency outpatient service due to left lower quadrant pain and vomiting as chief complaints. Abdominal findings showed tenderness with the severest point in the left lower quadrant of the abdomen. Contrast-enhanced CT showed poor imaging of the dorsal sigmoid colon and an expanded proximal small intestine, with regional ascites around the small intestines. The patient was diagnosed with small bowel obstruction associated with ISH incarceration and underwent emergency surgery. Invagination of the small intestine into the intersigmoid fossa was found by laparoscopy. The incarcerated part was removed and the hernia orifice was sutured and closed. Mild congestion was seen in the incarcerated small intestine, but with no findings of ischemia. Thus, intestinal resection was determined to be unnecessary. The postoperative course was good and the patient was discharged on postoperative day 6. CLINICAL DISCUSSION ISH is often diagnosed as simple ileus at the initial visit, which can result in delayed surgery. There are no case reports of complete remission of ISH with conservative therapy, and treatment with surgery is generally required. Our patient underwent early surgery because of CT findings that were characteristic of ISH and allowed diagnosis before surgery. CONCLUSION Early diagnosis of ISH and performance of laparoscopic surgery can avoid the need for intestinal resection.
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Affiliation(s)
- Hiroyuki Kambe
- Department of Surgery, Kobe City Medical Center General Hospital, Japan.
| | - Koji Kitamura
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
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Nakaseko Y, Haruki K, Neki K, Hashizume R, Eto K, Yanaga K. Laparoscopy-Assisted Repair for Intersigmoid Hernia. Case Rep Gastroenterol 2020; 14:675-682. [PMID: 33442348 PMCID: PMC7772840 DOI: 10.1159/000509499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 01/18/2023] Open
Abstract
Intersigmoid hernia is a rare clinical entity. Only 6 cases of laparoscopic repair for intersigmoid hernia have been reported since 1977. We herein report such a case, which was successfully diagnosed preoperatively and treated with laparoscopic repair. A 50-year-old man with a chief complaint of abdominal pain and vomiting was admitted for the treatment of small bowel obstruction. The patient had no history of abdominal surgery. Computed tomography showed a dilated small bowel and a closed loop of small bowel dorsal to the sigmoid colon and the sigmoid mesocolon. With a diagnosis of an incarcerated internal hernia, the patient underwent emergency laparoscopy-assisted surgery. Laparoscopy showed that the ileum had herniated into the intersigmoid fossa, and therefore the patient was diagnosed with an intersigmoid hernia. Because bowel ischemia was not observed, we reduced the incarcerated small bowel, and the hernial defect was widely opened. After operation, the patient developed ileus and was treated with transnasal ileus tube. Thereafter, the patient made a satisfactory recovery and was discharged on postoperative day 21. The patient is in good general condition without ileus 42 months postoperatively.
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Affiliation(s)
- Yuichi Nakaseko
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichiro Haruki
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kai Neki
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Hashizume
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Eto
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Yanaga
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Intersigmoid Hernia: A Forgotten Diagnosis-A Systematic Review of the Literature over Anatomical, Diagnostic, Surgical, and Medicolegal Aspects. Emerg Med Int 2020; 2020:4891796. [PMID: 32566302 PMCID: PMC7285387 DOI: 10.1155/2020/4891796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/24/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. The purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results The diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1-10 cm, SD 1.15 cm) and the length of the incarcerated small intestine was between 3 cm (min) and 150 cm (max): mean 25.25 cm, SD 35.04 cm. The diameter of the sigmoid recess was greater in patients who underwent resection due to strangulation (mean 3.31 cm, SD 1.53 cm) compared to those who underwent only reduction of the hernia (mean 2.35 cm, SD 0.74 cm). The time from onset to operation was less in patients undergoing resection surgery due to throttling (mean 3.03 days, SD 3.01 days) compared to those who underwent only a reduction of hernia incarceration (mean 8.49 days, SD 6.83 days). Conclusion Intersigmoid hernia is often a forgotten diagnosis and a clinical challange due to its anatomical characteristics.
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Fujimoto Y, Ohya Y, Hayashida S, Iizaka M, Maeda Y, Kumamoto S, Tsuji A, Shibata H, Kuramoto K, Hayashi H, Nakahara O, Tomiyasu S, Inomata Y. Laparoscopic surgery for two patients with strangulated transomental hernias. Surg Case Rep 2020; 6:53. [PMID: 32189140 PMCID: PMC7080934 DOI: 10.1186/s40792-020-00815-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background Transomental hernias are a rare type of internal hernia. We report two cases of successful cases of laparoscopic repair. One required laparotomy due to concern for intestinal viability. Case presentation The first patient was a 67-year-old man who presented with abdominal pain and vomiting. He had no history of laparotomy or abdominal injury. Computed tomography suggested small bowel obstruction and possible intestinal strangulation. Emergent laparoscopy found approximately 200 cm of small bowel was strangulated around the greater omentum. The strangulation was released laparoscopically, but because of the color of the strangulated bowel, laparotomy was performed to evaluate viability. The involved portion of intestine was not resected. The patient experienced transient postoperative paralytic ileus and was discharged on postoperative day 14. The second patient was a 56-year-old man who presented with abdominal pain. Abdominal computed tomography revealed dilatation of the small intestine and a closed loop suggesting ileus due to intestinal strangulation. An emergency laparoscopy found a transomental hernia, and the strangulation was released laparoscopically. Recovery was uneventful, and the patient was discharged on postoperative day 6. Conclusion Transomental hernia can be successfully treated laparoscopically. In cases where bowel viability is a concern, laparotomy should not be hesitated.
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Affiliation(s)
- Yuka Fujimoto
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Yuki Ohya
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan.
| | - Shintaro Hayashida
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Masayoshi Iizaka
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Yuto Maeda
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Sayahito Kumamoto
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Akira Tsuji
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Hidekatsu Shibata
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Kunitaka Kuramoto
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Hironori Hayashi
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Osamu Nakahara
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Shinjiro Tomiyasu
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Yukihiro Inomata
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
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Tatsuta K, Miyazaki S, Nishiwaki Y. Emergency laparoscopic approach without sufficient preoperative decompression for intersigmoid hernia: A case report. Int J Surg Case Rep 2019; 64:54-57. [PMID: 31600670 PMCID: PMC6796653 DOI: 10.1016/j.ijscr.2019.09.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
Emergency laparoscopy can be performed without sufficient small bowel decompression. MDCT is advantageous for preoperatively recognizing anatomical relationships. Careful preoperative diagnosis and emergency laparoscopy can lead to good outcomes.
Introduction In acute care surgery, an increasing number of patients operatively treated for small bowel obstruction undergo laparoscopic procedures. However, intersigmoid hernia is a rare condition. In some reports, surgeons have successfully operated on patients with an intersigmoid hernia via a laparoscopic approach. The laparoscopic approach has the advantage of facilitating simultaneous diagnosis and surgical intervention for intersigmoid hernias. In the laparoscopic approach, sufficient decompression of the small bowel is preoperatively performed in most cases. Presentation of case We encountered a patient with an intersigmoid hernia who underwent an emergency laparoscopic approach without sufficient decompression. Because sufficient decompression of the small bowel was not preoperatively performed, it was difficult to establish a working space and visualize the site of obstruction; however, we performed the laparoscopic approach safely, and diagnosis and surgical intervention were possible. Moreover, the postoperative course was uneventful. Discussion We successfully performed an emergency surgery using a laparoscopic approach for an intersigmoid hernia without sufficient decompression. The success of the procedure is attributable to the disease-specific surgical strategy, surgical technique, and the recent technological advances in multidetector-row computed tomography. Conclusion We believe that careful preoperative diagnosis and strategy can lead to a good outcome and that the significance of emergency laparoscopic approach without sufficient decompression will keep increasing.
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Affiliation(s)
- Kyota Tatsuta
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
| | - Shinichiro Miyazaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
| | - Yoshiro Nishiwaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
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Shi WH, Chao HQ, Ye NY, Shi HJ. Ileus tube placement combined with laparoscopy in the treatment of refractory small bowel obstruction: Case series and literature review. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii170020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Wei-Hai Shi
- Department of General Surgery, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
| | - Hao-Qiang Chao
- Department of Radiology, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
| | - Nian-Yuan Ye
- Department of General Surgery, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
| | - Hong-Jian Shi
- Department of Radiology, The Affiliated Wujin Hospital, Jiangsu University, Changzhou, China
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Nagano H, Goi T, Taguchi S, Tsubaki T, Uematsu H. Diagnosis of incarcerated intramesosigmoid hernia aided by multiplanar reconstruction images of multidetector computed tomography: a case report. Surg Case Rep 2018; 4:128. [PMID: 30343419 PMCID: PMC6195874 DOI: 10.1186/s40792-018-0535-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Internal hernia is a rare cause of intestinal obstruction, and sigmoid mesocolon hernia is an extremely rare form of this condition. Among sigmoid mesocolon hernias, intramesosigmoid hernia is the least frequent subtype. We described a case of intramesosigmoid hernia through the orifice on the right leaf of the mesosigmoid with an incarcerated ileum of 6 cm in length without strangulation. This case was diagnosed by multidetector computed tomography with multiplanar reconstruction images and treated without resection of the small intestine in a 52-year-old man with characteristic diagnostic images. Case presentation A 52-year-old man suffering periumbilical cramping pain with sudden onset that had persisted for 1 week without recovery was referred to Fukui Katsuyama General Hospital. Multidetector computed tomography revealed small bowel obstruction, and an incarcerated short intestinal loop was revealed by sagittal slices of the multiplanar reconstruction images of the routine study of the left side of the pelvic space. Sagittal multiplanar reconstruction images also showed narrow belt-shaped fluid retention contacting the tip of the incarcerated short loop toward the cranial direction localized in the mesosigmoid. These findings indicated that the fluid and the herniated small bowel were wrapped together in the mesosigmoid, which was characteristic of intramesosigmoid hernia. The patient underwent laparotomy operation 2 days after admission. The ileum, which was approximately 75 cm proximal to the ileocecal junction and herniated into the mesosigmoid through the right leaf, was released without resection. The orifice located in the central part of the right leaf was oval shaped and measured less than 2 cm in diameter. The left leaf of the mesosigmoid was intact. The orifice of the right lobe was closed by suture. The patient showed an uneventful recovery. Conclusion We report an extremely rare case of incarcerated intramesosigmoid hernia that was diagnosed by multidetector computed tomography with multiplanar reconstruction images. The finding of narrow belt-shaped fluid retention contacting the tip of the incarcerated short intestinal loop is characteristic of intramesosigmoid hernia and will be useful for conclusively differentiating this disease from transmesosigmoid hernia. Although intramesosigmoid hernia is a rare cause of internal hernia, multidetector computed tomography and multiplanar reconstruction images can provide the characteristic findings and proved useful for the precise preoperative diagnosis and treatment of intramesosigmoid hernia.
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Affiliation(s)
- Hideki Nagano
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan.
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Seiichi Taguchi
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan
| | - Takayoshi Tsubaki
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan
| | - Hidemasa Uematsu
- Department of Radiology, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan
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