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Salman R, Seghers VJ, Schiess DM, Nguyen HN, Sher AC, Mertiri L, Sammer MBK. Ultrasound imaging of bowel obstruction in infants and children. LA RADIOLOGIA MEDICA 2024; 129:1241-1251. [PMID: 39017759 DOI: 10.1007/s11547-024-01854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
We review the etiologies of bowel obstruction in infants and children that can be identified on ultrasound (US) including perforated appendicitis, intussusception, foreign body ingestion, colonic volvulus, intra-abdominal mass lesions, internal hernia, and stricturing inflammatory bowel disease. US can potentially identify the cause of bowel obstruction in these age groups, without the need for additional cross-sectional imaging, and can aid in patient management including interventional and surgical planning. Hence, it is important to be familiar with the sonographic imaging findings of bowel obstruction in infants and children.
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Affiliation(s)
- Rida Salman
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Victor J Seghers
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Desi M Schiess
- Pediatric Section, Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - HaiThuy N Nguyen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew C Sher
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Livja Mertiri
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Marla B K Sammer
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA.
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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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Irizarry AC. A case study of an acute internal hernia: The complex diagnostic challenges of Roux-en-Y gastric bypass complications. J Am Assoc Nurse Pract 2024; 36:409-412. [PMID: 38687679 DOI: 10.1097/jxx.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
ABSTRACT Obesity remains a global health challenge linked to several comorbidities, such as obstructive sleep apnea, hypertension, hyperlipidemia, and diabetes. The prevalence of bariatric surgeries being performed is steadily increasing because it is a highly effective surgical tool used to achieve significant permanent weight loss. However, with all weight loss surgeries, several complications may not present for months to years after the initial procedure. In particular, the anatomical changes that occur after the Roux-en-Y gastric bypass (RNYGB) make the risk of internal hernias high. This particular complication is rare but lethal if unrecognized and not treated promptly. This clinical case study aims to provide readers with an overview of diagnosing and recognizing an internal hernia in the setting of previous laparoscopic RNYGB surgical history. Because of the sheer increase in the volume of patients undergoing bariatric surgery worldwide, health care providers must be well educated on the insidious presentations of this late complication and be prepared to act quickly to diagnose and treat these acute abdomen scenarios.
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Affiliation(s)
- Angela C Irizarry
- Mayo Clinic Florida, Preoperative Evaluation Clinic, Jacksonville, Florida
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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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Hua L, Huang Y, Liu H, Chen J, Tang Y. Diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias: a retrospective study. BMC Surg 2024; 24:190. [PMID: 38886699 PMCID: PMC11181668 DOI: 10.1186/s12893-024-02478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. METHODS A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. RESULTS Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with "cross sign" as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. DISCUSSION IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.
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Affiliation(s)
- Lichun Hua
- Department of Ultrasound, Children's Hospital of Nanjing Medical University, No. 88, Jiangdong East Road, Jianye District, Nanjing, Jiangsu, P.R. China
| | - Yaqing Huang
- Department of Radiology, Children's Hospital of Nanjing Medical University, No. 88, Jiangdong East Road, Jianye District, Nanjing, Jiangsu, P.R. China
| | - Hui Liu
- Department of Ultrasound, Children's Hospital of Nanjing Medical University, No. 88, Jiangdong East Road, Jianye District, Nanjing, Jiangsu, P.R. China
| | - Jun Chen
- Department of Ultrasound, Children's Hospital of Nanjing Medical University, No. 88, Jiangdong East Road, Jianye District, Nanjing, Jiangsu, P.R. China
| | - Ying Tang
- Department of Ultrasound, Children's Hospital of Nanjing Medical University, No. 88, Jiangdong East Road, Jianye District, Nanjing, Jiangsu, P.R. China.
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Nguyen BH, Mcguirt AS. Radiographic Features of a Strangulated Transomental Hernia. Cureus 2024; 16:e62484. [PMID: 39022475 PMCID: PMC11251898 DOI: 10.7759/cureus.62484] [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: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
This is a case report of an 82-year-old male who presented with intractable and diffuse abdominal pain and had a computed tomography (CT) abdomen showing a closed loop obstruction in the right hemiabdomen with anteromedial displacement of the cecum and ascending colon. Exploratory laparotomy revealed a gangrenous segment of the ileum strangulated by a transomental hernia in the right lower quadrant. The nonviable bowel was resected, and the healthy bowel segments were anastomosed. It is important to correlate the clinical signs of bowel obstruction with radiographic findings of internal hernia to expedite surgical intervention and prevent complications of bowel ischemia.
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Affiliation(s)
- Bao H Nguyen
- General Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Aron S Mcguirt
- General Surgery, Bay Pines VA Health Care system, St. Petersburg, USA
- General Surgery, University of Central Florida College of Medicine, Orlando, USA
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Lundgren AM, Fader JP, Dufek GA, NaThalang-Piñon AG. Herniation of the Right Colon, From the Cecum to the Hepatic Flexure, Through the Foramen of Winslow: A Case Report. Cureus 2024; 16:e61387. [PMID: 38953091 PMCID: PMC11214930 DOI: 10.7759/cureus.61387] [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: 04/22/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Herniation of bowel contents between the peritoneal cavity proper and the omental bursa, through the foramen of Winslow, can present diagnostic challenges that can potentially delay necessary surgical intervention. This case describes a 49-year-old female with a past medical history of hiatal hernia and biliary dyskinesia who presented to the emergency department with severe epigastric and right lower quadrant abdominal pain one day after a reported gastrointestinal illness of unknown etiology. Initial emergency department workup demonstrated an elevated white blood cell count without lactic acidosis. Computed tomography imaging was interpreted as gastric distension with volvulus around the mesentery and second portion of the duodenum. Intraoperatively, the entirety of the right colon was noted to have passed through the foramen of Winslow into the lesser sac. This led to twisting of the mesocolon causing compression of the duodenum and a gastric outlet obstruction. After surgical reduction of the herniation, the patient noted great improvement in pain and other symptoms.
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Affiliation(s)
| | | | | | - Ani G NaThalang-Piñon
- General Surgery, University of Missouri Capital Region Medical Center, Jefferson City, USA
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Tomita D, Fujisawa K, Ohkura Y, Ueno M, Udagawa H. Internal Hernia Through a Mesenteric Defect Following Esophagectomy and Reconstruction With a Stomach-Preserved Ileocolic Interposition. Cureus 2024; 16:e56244. [PMID: 38495965 PMCID: PMC10944547 DOI: 10.7759/cureus.56244] [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: 03/15/2024] [Indexed: 03/19/2024] Open
Abstract
Esophagectomy is the standard treatment for esophageal cancer and often involves the stomach as a substitute organ for esophageal reconstruction. However, we actively perform stomach-preserved ileocolic interposition because of its advantages in gastrointestinal function and the prevention of reflux esophagitis. Despite its benefits, few facilities perform esophageal reconstruction with ileocolic interposition; hence, postoperative complications following this procedure have rarely been reported. We present the first case of internal hernia through a mesenteric defect following esophagectomy and reconstruction with a stomach-preserved ileocolic interposition. This type of internal hernia after esophageal cancer surgery is a rare complication following a common gastric pull-up reconstruction. A 66-year-old Japanese female underwent esophagectomy and reconstruction with stomach-preserved ileocolic interposition for stage I esophageal cancer. One month after surgery, the patient experienced abdominal pain and vomiting. CT showed a dilated small bowel and a suspected postoperative adhesive bowel obstruction. Despite conservative management, the patient experienced recurrent episodes that required hospitalization. Although an exact preoperative diagnosis was not made, we decided on a surgical exploration six months after the first symptoms appeared. Laparotomy revealed an internal herniation through a mesenteric defect between the transverse mesocolon and the ileum mesentery following ileocolic interposition. We then repositioned the fitted small intestine and closed the mesenteric defects. The patient recovered uneventfully without a hernia recurrence. Minimally invasive techniques for treating esophageal cancer are becoming more common. As survival rates improve, the number of internal hernia cases, such as those described in this report, will likely increase. Therefore, more cases are needed to determine whether closing mesenteric defects can effectively prevent herniation. However, immediate surgical treatment should be considered based on the symptoms, even when a preoperative diagnosis is difficult.
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Affiliation(s)
- Daisuke Tomita
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
| | - Kentoku Fujisawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, JPN
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AlSarraj OM, Alqahtani A, Alqahtani FS, Billa S, AlMayouf M. Internal Hernia as a Rare Complication of Acute Appendicitis. Cureus 2024; 16:e56613. [PMID: 38646293 PMCID: PMC11031648 DOI: 10.7759/cureus.56613] [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: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Appendicitis is a well-known and highly common surgical emergency disease, yet it presents with a wide variety of manifestations. This is a case report of a 47-year-old female who presented with a complaint of having constant crampy right lower abdominal pain for two weeks. The patient reported having a sudden onset of symptoms that went with the typical picture of acute appendicitis that occurred two weeks ago. Our pre-op workup was inconclusive; therefore, we planned to go for a diagnostic laparoscopy, where surprisingly, the appendix was long, inflamed, and attached to the posterior wall of the cecum. Thus, a ring-like structure was developed, in which 8 to 10 cm of the terminal ileum (the last part of the small bowel) was going through and causing an internal hernia. Although blood and radiology workups provide valuable assistance in diagnosing common cases, a highly suspicious sense and skillful surgeons with good clinical experience play a major role in managing such rare presentations.
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Affiliation(s)
- Omar M AlSarraj
- Department of Surgery, Sulaiman Al-Habib Hospitals, Riyadh, SAU
| | | | - Faisal S Alqahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Srikar Billa
- Department of Surgery, Sulaiman Al-Habib Hospitals, Riyadh, SAU
| | - Mohammed AlMayouf
- College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, SAU
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El Nogoomi I, Nouh AK, Jaber AA, Toubah AM, Alkaram SS. Petersen's Hernia After Roux-en-Y Gastric Bypass: A Case Report. Cureus 2023; 15:e50757. [PMID: 38239520 PMCID: PMC10796129 DOI: 10.7759/cureus.50757] [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: 12/16/2023] [Indexed: 01/22/2024] Open
Abstract
Internal hernia (IH) is the protrusion of abdominal contents, mostly small bowel loops, through a defect in the peritoneum or mesentery. Petersen's hernia is a type of internal hernia, in which part of the intestinal loop protrudes through a defect between small bowel limbs, transverse mesocolon, and retroperitoneum. It has been reported in individuals undergoing gastrojejunostomy (GJ), especially following bariatric surgeries. Because of the expanding popularity of these surgical treatments, the total incidence of internal hernias has recently increased. The laparoscopic Roux-en-Y gastric bypass (RYGB) has been proven to be a safe and successful alternative to the classic open RYGB. Although the absence of postoperative adhesions is one advantage of minimally invasive surgery, it facilitates the occurrence of internal hernia with reported rates of 5% three months to three years following surgery. Clinical findings are vague and can vary from mild to severe abdominal pain that can be accompanied by vomiting, nausea, and abdominal distention.
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Affiliation(s)
| | | | | | | | - Sana S Alkaram
- Department of General Surgery, Al Kuwait Hospital, Sharjah, ARE
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Ahmet Surel A, İshak Işık N, Yazla M. Untangling diagnostic confusion in internal abdominal hernias. ULUS TRAVMA ACIL CER 2023; 29:1114-1121. [PMID: 37791450 PMCID: PMC10644087 DOI: 10.14744/tjtes.2023.36037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 08/21/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Internal hernias involve the herniation of intestines through mesenteric or peritoneal defects in the gastrointestinal system. Etiologically, they are generally classified as congenital or acquired. Internal hernias often present with non-specific symptoms. Despite the increased use of computed tomography (CT), discrepancies between imaging findings and diagnostic accuracy continue to pose challenges for clinicians. This study aims to compare the outcomes of patients presenting to the emergency department with abdominal pain and receiving a preliminary internal hernia diagnosis through CT, followed by laparotomy. METHODS Our research is a retrospective, observational, and descriptive study. It includes patients presenting to the emergency department with abdominal pain, who were provisionally diagnosed with internal hernia based on CT. Patient data recorded age, gen-der, CT-identified internal hernia type, surgery, diagnoses, hospitalization status, duration of hospital stay, bowel resection, mortality, and blood parameters. The Welch classification was used to categorize internal hernia types, with eight types examined. RESULTS Among 112 patients with a preliminary internal hernia diagnosis based on abdominal CT, the median age was 52 years. Of these, 46 were female and 66 were male. Among all patients, 87 were admitted to the hospital for observation and surgery, while 25 were discharged after emergency department. Paraduodenal hernias were the most common provisional diagnosis (48 cases). Among these patients, 45 were discharged after symptom relief and were advised for elective re-evaluation. The exact diagnosis for these pa-tients remains unknown. Post-surgery, the diagnosis of internal hernia was confirmed in 32 cases. Among them, 15 were female and 17 were male, with a median age of 52. The median hospital stay for patients diagnosed with internal hernia was 5 days. Although acquired hernias exhibited higher resection and mortality rates, no statistically significant difference was found. Thirty-five cases received dif-ferent diagnoses: 19 had brid ileus, five had volvulus, six had acute appendicitis, one had duodenal perforation, three had gynecological malignancies, and one had renal malignancy. CONCLUSION Although internal hernias are rare, early diagnosis and treatment are very important due to the high risk of death. The study findings indicate that increased CT utilization leads to earlier diagnosis and treatment, resulting in improved prognosis for patients. This study holds one of the largest case series in the literature. It provides a novel perspective by evaluating radiologically-diagnosed cases, confirming diagnoses post-surgery, and comparing conditions that mimic internal hernias, thereby making a valuable contribution to the literature.
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Affiliation(s)
- Aziz Ahmet Surel
- Department of General Surgery, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Nurullah İshak Işık
- Department of Emergency Medicine, Ankara Etlik City Hospital, Ankara-Türkiye
| | - Merve Yazla
- Department of Emergency Medicine, Ankara Etlik City Hospital, Ankara-Türkiye
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12
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Samuelson AG, Damron LF, Haddadin Z, Adnan SM, Neff M. Multiple Internal Hernias: A Complication of Laparoscopic Roux-en-Y Gastric Bypass. CRSLS : MIS CASE REPORTS FROM SLS 2023; 10:e2023.00040. [PMID: 38226185 PMCID: PMC10789439 DOI: 10.4293/crsls.2023.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Introduction Internal hernias are the most common cause of small bowel obstruction following laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP) with four distinct types. Herein, we report the clinical course of a patient with two independent hernias at the Petersen's space and a rarer subtype at the jejunojejunal window. A high index of suspicion for less common subtypes of internal hernias and the possibility of multiple, simultaneous internal hernias is critical. Case Description We describe the case of a 52-year-old female with a history of LRYGBP who presented with abdominal pain and emesis due to an internal hernia at Peterson's defect, requiring subsequent laparoscopic repair. On postoperative day three, the patient presented again with recurrent abdominal pain and emesis. Repeat exploratory laparoscopy found a separate internal hernia involving the jejunojejunal window with the previously repaired Petersen's defect intact. Discussion This case illustrates a unique scenario of a patient post-LRYGBP with multiple internal hernias at the Peterson's space and the less common jejunojejunal window, which was missed during the index surgery. Failure to identify simultaneous hernias may result in additional invasive intervention and further morbidity. Conclusion Multiple less-common variants of internal hernias may present simultaneously following LRYGBP.
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Affiliation(s)
- Annika G Samuelson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. (Ms. Samuelson, Mr. Damron)
| | - Leland F Damron
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. (Ms. Samuelson and Ms. Damron)
| | - Zaid Haddadin
- Department of Surgery, Einstein Healthcare Network/Jefferson Health, Philadelphia, PA. (Drs. Haddadin and Adnan)
| | - Sakib M Adnan
- Department of Surgery, Einstein Healthcare Network/Jefferson Health, Philadelphia, PA. (Drs. Haddadin and Adnan)
| | - Marc Neff
- Department of Bariatric and General Surgery, Jefferson Health New Jersey, Cherry Hill, NJ. (Dr. Neff)
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Ping Wei S, Abdul Karim NK, Aziz ME, Shong Sheng T. Adhesional Omental Hernia With Small Bowel Obstruction in an Elderly Patient With a Virgin Abdomen: A Case Report. Cureus 2023; 15:e43365. [PMID: 37700966 PMCID: PMC10494554 DOI: 10.7759/cureus.43365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Small bowel obstruction is a frequently encountered surgical condition in adults. Its most prevalent causes include adhesions resulting from prior abdominal surgery or peritoneal infection. However, cases of small bowel obstruction caused by omental bands in elderly individuals with no prior abdominal surgeries are exceedingly rare, with only a few reported in the literature. Here, we report a case of an elderly patient with small bowel obstruction caused by internal herniation through an omental band, without prior abdominal surgery or trauma. The initial impression was mesenteric ischemia, which posed a diagnostic dilemma as the patient did not exhibit any clinical risk factors for mesenteric ischemia with absent history of previous trauma or abdominal surgery. A computed tomography (CT) scan was performed, revealing clustering of small bowel loops in the right hemiabdomen with mild dilatation and a close loop configuration indicative of an internal hernia. Internal hernias are rare and challenging to diagnose clinically as they lack specific signs and symptoms. In this case, CT played a crucial role in enabling preoperative diagnosis of an internal hernia and guiding early management.
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Affiliation(s)
- Saw Ping Wei
- Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Noor Khairiah Abdul Karim
- Department of Radiology, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, MYS
| | - Mohd Ezane Aziz
- Department of Radiology, Universiti Sains Malaysia/Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Tan Shong Sheng
- Department of Surgery, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
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Khalid A, Ashraf A, Salman MA, Newton RC. Internal Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review. Cureus 2023; 15:e42960. [PMID: 37667721 PMCID: PMC10475313 DOI: 10.7759/cureus.42960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/06/2023] Open
Abstract
Internal abdominal hernias are rare entities that most commonly present with acute small bowel obstruction. These hernias can be congenital or acquired. While congenital hernias are considered the most common type, acquired hernias are becoming more common. Recently, a rare type of internal herniation has been reported underneath iliac vasculature in patients who have undergone pelvic lymph node dissection in the past. This study was carried out to assess the prevalence of this rare type of internal hernia. Two reviewers searched the literature in three online databases using the Cochrane methodology for systematic reviews. The search of databases yielded 70 articles. The studies which reported internal herniation underneath iliac vasculature were included. Studies that reported herniation underneath other pelvic organs or vasculature were excluded. After screening, 17 articles were deemed suitable and selected. All 17 cases reviewed underwent pelvic lymph node dissection in the past. The median latency period between index surgery and clinical presentation with the incarcerated hernia was 20 months. All 17 cases were managed surgically with small bowel resection carried out in 13 cases. Eleven authors reported closing the hernia defect with various techniques, while five decided not the close it. All 17 cases were alive at the time of discharge from the hospital, with a mean hospital stay of 12.7 days. Given our findings, there should be a high index of suspicion of internal hernia in patients presenting with small bowel obstruction with a history of pelvic lymph node dissection. In our review, internal herniation was always preceded by pelvic lymph node dissection, so the closure of the peritoneum should be considered while pelvic lymph node dissection is carried out.
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Affiliation(s)
- Aizaz Khalid
- General Surgery, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Chichester, GBR
| | - Anza Ashraf
- General Surgery/Urology, Frimley Health National Health Service (NHS) Foundation Trust, Slough, GBR
| | - Mohamed A Salman
- General Surgery, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Chichester, GBR
- General Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Richard C Newton
- General Surgery, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Chichester, GBR
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15
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Ulhaq E, Loufopoulos I, Halahakoon VC. Laparoscopic Management of Para-Caecal Hernia With Small Bowel Obstruction: A Case Report. Cureus 2023; 15:e42642. [PMID: 37644951 PMCID: PMC10461410 DOI: 10.7759/cureus.42642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Para-caecal hernias are a rare type of internal hernias. They can cause bowel obstruction, leading to strangulation of the bowel. As such, urgent diagnosis and appropriate management are important. Both laparoscopic and open approaches are options in terms of surgical treatment. We report a case of a para-caecal hernia causing small bowel obstruction and highlight the laparoscopic approach as a feasible and effective way of management.
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Affiliation(s)
- Ehsan Ulhaq
- General and Colorectal Surgery, Colchester Hospital/East Suffolk North Essex NHS Foundation Trust, Colchester, GBR
| | - Ioannis Loufopoulos
- General and Colorectal Surgery, Colchester Hospital/East Suffolk North Essex NHS Foundation Trust, Colchester, GBR
| | - Vijitha Chandima Halahakoon
- General and Colorectal Surgery, Colchester Hospital/East Suffolk North Essex NHS Foundation Trust, Colchester, GBR
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16
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Hina A, Zahid MJ, Jan MA, Haseeb A, Hussain M. From Recurrent Pain to a Life-Threatening Condition: A Case Report of Left Paraduodenal Hernia. Cureus 2023; 15:e42596. [PMID: 37641743 PMCID: PMC10460500 DOI: 10.7759/cureus.42596] [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: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Paraduodenal hernia (PDH) is the most frequent type of congenital hernia, especially on the left side. Although acute intestinal obstruction due to internal hernias is rare, it can be life-threatening if not detected and treated promptly. Here, we present the case of a 36-year-old man who presented to the emergency department with an acute intestinal obstruction that had been developing for three days. The patient had a history of recurrent abdominal pain but had never undergone any abdominal surgery. Surgical exploration revealed a left internal PDH with a collection of incarcerated jejunal loops retrocolically encased within the hernial sac. Resection of the gangrenous jejunal loops was performed, followed by hernia reduction and neck closure. This case highlights the importance of timely and accurate diagnosis of left PDHs, particularly in patients with a history of recurrent abdominal pain and no prior abdominal surgeries. Early detection and treatment can prevent life-threatening complications such as intestinal perforation and peritonitis.
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Affiliation(s)
- Ayesha Hina
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | | | - Abdul Haseeb
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Musarrat Hussain
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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17
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Mare H, Tjhin W. Successful Laparoscopic Management of Pericaecal Hernia Causing Small Bowel Obstruction. Cureus 2023; 15:e34663. [PMID: 36909093 PMCID: PMC9993124 DOI: 10.7759/cureus.34663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/09/2023] Open
Abstract
Management of small bowel obstruction varies depending on the cause and clinical status of patients. While most cases can be managed conservatively, a not-insignificant proportion of patients undergo surgical intervention. Laparotomy has long been the default approach for entering the abdomen in cases requiring surgical intervention, with laparoscopy largely being avoided due to abdominal distension and the risk of perforating bowels on entry. We present here the case of a 54-year-old woman who presented with signs and symptoms as well as radiological evidence of a closed-loop small bowel obstruction in her right lower quadrant. Following a brief period of nasogastric decompression, her abdominal distension improved, allowing for a laparoscopic entry where a pericaecal hernia was noted to be the cause of her obstruction. Extensive adhesiolysis without the use of an energy device successfully allowed for the reduction of the bowel contained within. No bowel resection was performed and the patient was discharged home on day 3 following her procedure. This case report successfully demonstrates the utility of using laparoscopy as an alternative to laparotomy in patients with a small bowel obstruction secondary to an internal hernia.
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Affiliation(s)
- Hans Mare
- General Surgery, Rockingham General Hospital, Rockingham, AUS
| | - William Tjhin
- General Surgery, Rockingham General Hospital, Rockingham, AUS
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18
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Muacevic A, Adler JR, Baty S, Sherali S, Soliman B. An Unusual Presentation of Cecal Volvulus With Internal Herniation Through the Foramen of Winslow. Cureus 2022; 14:e32960. [PMID: 36712739 PMCID: PMC9875865 DOI: 10.7759/cureus.32960] [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: 12/25/2022] [Indexed: 12/27/2022] Open
Abstract
Internal hernias through the Foramen of Winslow account for 0.1% of abdominal hernias and 8% of internal hernias, with a mortality rate of 36%-49%. Cecal volvulus accounts for only 1%-1.5% of all intestinal obstructions with a mortality rate of up to 48%. We present a case of a 56-year-old female evaluated for lower abdominal pain and nausea who received a right hemicolectomy after reduction of a cecal volvulus with internal herniation through the Foramen of Winslow. The ambiguous presentation can complicate initial management, but early detection is essential for quick operative repair and prevention of onset or progression of bowel ischemia and necrosis.
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19
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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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20
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Litchinko A, Kohler R, Jung MK, Toso C, Moenig S. Simultaneous Winslow and Petersen’s Hernias after a Roux-en-Y Gastric Bypass Causing Bowel Obstruction: Laparoscopic Management and Review of the Literature. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractInternal hernias after Roux-en-Y gastric bypass are one of the most common complications in bariatric surgery leading to hospital readmissions with or without surgery. Due to the insidious and non-specific clinical presentation combined with difficult radiological identification, internal hernias remain a diagnostic and therapeutic challenge. Delay in diagnosis and treatment can lead to severe morbidity and mortality. We report the case of a patient presenting an unusual intestinal obstruction due to two simultaneous and distinct internals hernias affecting the Petersen’s defect and the foramen of Winslow 4 years after a laparoscopic gastric bypass. A 41-year-old female patient with a history of robotic laparoscopic Roux-en-Y gastric bypass presented with proximal small bowel obstruction symptoms and epigastric pain. Computed tomography showed two simultaneous internal hernias, one affecting the Petersen’s defect and the other affecting the foramen of Winslow with an incarcerated transverse colon. We performed an explorative laparoscopy to reduce both hernias and, after an assessment of bowel viability by indocyanine green angiography, we closed both defects with interrupted non-absorbable sutures to prevent recurrence. The follow-up of more than 1 year has been uneventful. In the cases of obstruction and hospital admission after gastric bypass, we suggest that patients undergo a computed tomography directly after the initial examination. Internal hernia diagnosis is often delicate and requires surgical exploration since bowel strangulation can lead to dramatic outcomes. The operation can be safely done laparoscopically, and all internal hernia defects should be repaired with non-absorbable sutures.
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21
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Mansour M, Alabrach YS, Eladl M, Attia KE, El Nogoomi I. Sclerosing Encapsulating Peritonitis Mimicking an Internal Hernia: A Case Report. Cureus 2022; 14:e28476. [PMID: 36176872 PMCID: PMC9512256 DOI: 10.7759/cureus.28476] [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] [Accepted: 08/27/2022] [Indexed: 11/12/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare entity that could lead to abdominal obstruction; however, despite being reported in several case series, its underlying pathophysiology is still unclear. A large proportion of SEP cases are diagnosed incidentally or after surgical exploration, which poses a great challenge to pre-operative diagnosis. We hereby report a case of a 33-year-old male patient who presented with cachexia and a clinical picture of complete small bowel obstruction. CT scan of the abdomen raised suspicion of an internal hernia, prompting explorative surgical evaluation. Laparoscopy showed encasement of the small bowel loops in a thick fibrocollagenous membrane characteristic of SEP. Laparotomy with adhesiolysis and membrane excision successfully led to the resolution of obstruction. Retrospective interpretation of the initial CT scan confirmed the presence of SEP’s characteristic radiological signs and provided an insight into how it contrasts with an internal hernia. This case provides an opportunity to highlight the differences between the two clinical entities and the pre-operative diagnostic strategies.
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22
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Chandhrasekhar D, Droger A, Baatz M, Chapuis T, Fox-McClary DJ. A Twisted Cecum: Herniation and Volvulus of the Cecum Through the Epiploic Foramen. Cureus 2022; 14:e27754. [PMID: 36106284 PMCID: PMC9445405 DOI: 10.7759/cureus.27754] [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: 05/23/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
Herniation of the cecum, terminal ileum, and ascending colon through the epiploic foramen is an uncommon presentation of an internal hernia. An 82-year-old female presented with a small bowel obstruction; Computed Tomography (CT) imaging showed a herniation of the terminal ileum, cecum, and ascending colon through the foramen of Winslow into the lesser sac, with cecal volvulus. Prompt surgical treatment included laparotomy and reduction of the hernia, followed by an extended right hemicolectomy with primary anastomosis and functional closure of the epiploic foramen. This report reviews the natural history and management of this rare pathology.
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23
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Wolfe C, Halsey-Nichols M, Ritter K, McCoin N. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med 2022; 14:335-345. [PMID: 35899220 PMCID: PMC9309319 DOI: 10.2147/oaem.s342724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Abdominal pain is a common presenting complaint in the emergency department, and utilization of diagnostic imaging is often a key tool in determining its etiology. Plain radiography has limited utility in this population. Computed tomography (CT) is the imaging modality of choice for undifferentiated abdominal pain. Ultrasound and magnetic resonance imaging may be helpful in specific scenarios, primarily in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT. Guidance for imaging selection is determined by location of pain, special patient considerations, and specific suspected etiologies. Expert guidance is offered by the American College of Radiology Appropriateness Criteria® which outlines imaging options based on location of pain.
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Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, TriStar Skyline Medical Center, Nashville, TN, USA
| | - Maglin Halsey-Nichols
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn Ritter
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, New Orleans, LA, USA
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24
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Giordano G, La Mirata E, Politi V, Veroux M, Meli GA, Evola G, Palmucci S, Basile A, Basile G. Left Paraduodenal Hernia in a Young Patient with Recurrent Abdominal Pain: A Case Report and Short Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e935413. [PMID: 35660720 PMCID: PMC9175513 DOI: 10.12659/ajcr.935413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/30/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Internal hernias are a rare cause of small bowel obstruction in patients, which usually have a long history of mild abdominal symptoms, sometimes leading to emergency surgery due to acute abdominal pain. Occasionally, it takes a long time to make the correct diagnosis because of symptoms vagueness and transience of typical imaging findings; at times, a definitive diagnosis is possible only through surgery, especially in cases of acute presentations in a low-resource setting where high-performance diagnostic equipment may be unavailable. CASE REPORT We report the case of a young male patient with a long history of mild abdominal symptoms and some episodes of acute abdominal pain. Following one of these episodes, several diagnostic examinations were performed and he was diagnosed with left paraduodenal hernia after typical signs were found on imaging exams, both CT and MRI; the patient underwent laparotomy with reduction of intestinal loops in the peritoneal cavity and suturing of the sac and was eventually discharged with no further symptoms whatsoever. CONCLUSIONS Among internal hernias, left paraduodenal hernias account for the major part and are characterized by the protrusion of bowel loops through the fossa of Landzert; herniated loops produce a sac-like appearance (typical imaging sign on both CT and MRI) and may cause partial displacement of other organs and blood vessels. Internal hernias should always be considered as a rare differential diagnosis in the workup of a patient with abdominal pain or intestinal obstruction: knowledge of both typical imaging features and specific surgical techniques are mandatory so that these patients may be properly cared for.
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Affiliation(s)
- Gabriele Giordano
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Elena La Mirata
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Valentina Politi
- UOC MCAU (Urgent Surgery), University Teaching Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Massimiliano Veroux
- Organ Transplantation Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Gaetano Alfio Meli
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Giuseppe Evola
- Department of General and Emergency Surgery, Garibaldi Hospital, Catania, Italy
| | - Stefano Palmucci
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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25
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The Role of Magnetic Resonance Enterography in Crohn’s Disease: A Review of Recent Literature. Diagnostics (Basel) 2022; 12:diagnostics12051236. [PMID: 35626391 PMCID: PMC9140029 DOI: 10.3390/diagnostics12051236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Inflammatory bowel disease (IBD) is the term used to identify a form of chronic inflammation of the gastrointestinal tract that primarily contemplates two major entities: ulcerative colitis (UC) and Crohn’s disease (CD). The classic signs are abdominal pain and diarrhoea that correlate with the localization of gastro-enteric disease, although in this pathology extraintestinal symptoms may coexist. The diagnosis of CD relies on a synergistic combination of clinical, laboratory (stool and biochemical), cross-sectional imaging evaluation, as well as endoscopic and histologic assessments. The purpose of this paper is to prove the role of imaging in the diagnosis and follow-up of patients with CD with particular focus on recent innovations of magnetic resonance enterography (MRE) as a pivotal diagnostic tool, analysing the MRE study protocol and imaging features during the various phases of disease activity and its complications.
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26
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Marzouk M, Al Abdulsalam A, Soliman A. Bowel Obstruction Caused by Broad Ligament Hernia Successfully Repaired by Laparoscopy in an Elderly Patient: A Case Report. Cureus 2022; 14:e23237. [PMID: 35350417 PMCID: PMC8933144 DOI: 10.7759/cureus.23237] [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] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
The most common causes of small bowel obstruction (SBO) are adhesions, Crohn’s disease, neoplasms, and hernias. Internal hernias are rare, and they occur when the small bowel herniates through a defect in the abdominal cavity. The occurrence of internal hernias due to a broad ligament defect is very rare and accounts for 4%-7% of cases of internal hernia. We present a case of a 71-year-old female who was previously healthy with no significant past medical or surgical history and who presented with symptoms of small bowel obstruction. Imaging with X-ray and computed tomography (CT) confirmed the diagnosis, but not the etiology. A decision was made to perform a laparoscopy to manage the obstruction, which revealed a healthy small bowel loop that herniated through a defect in the right broad ligament. Acute abdominal pain due to intestinal obstruction is a relatively common surgical emergency. Internal hernias are the consequence of the herniation of a bowel loop, most commonly the small bowel, through a peritoneal or mesenteric defect into a compartment in the abdominal and pelvic cavity, and they have a high mortality rate than can be higher than 50%. CT imaging is very useful in the diagnosis of internal hernias, although it may not always reveal the etiology. To facilitate wider recognition, broad ligament hernia should be in the differential diagnosis of internal hernias evident in the pelvis on CT imaging. Early recognition of small bowel obstruction caused by broad ligament internal hernia allows for prompt surgical management and vastly facilitates postoperative recovery. Although most surgeons opt for a laparotomy approach to manage such cases, a laparoscopic approach is feasible.
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27
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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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28
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Patel J, Hamedi A, Khalil M, El-Bahri J. Congenital Internal Hernia: Rare Cause of Acute Abdominal Pain. Case Rep Gastroenterol 2021; 15:791-794. [PMID: 34703421 PMCID: PMC8460935 DOI: 10.1159/000518293] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/01/2021] [Indexed: 12/17/2022] Open
Abstract
Acute abdominal pain is a common presenting symptom that possesses a wide differential. Congenital internal hernias are a rare condition that often presents with abdominal pain and can lead to obstruction. Early diagnosis is often difficult and therefore can present acutely and in an emergent setting. Prompt recognition of symptoms and evaluation are important to prevent poor prognosis. We are presenting a case of a congenital internal hernia in a patient presenting with nonspecific symptoms. Prompt diagnosis and subsequent surgical intervention allowed for appropriate management and resolution of symptoms.
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Affiliation(s)
- Jay Patel
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, Florida, USA
| | - Antoine Hamedi
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, Florida, USA
| | - Muhammad Khalil
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, Florida, USA
| | - Jessica El-Bahri
- Department of Internal Medicine, Orange Park Medical Center, Orange Park, Florida, USA
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29
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Mohakud S, Naik S, Deep N, Singh A, Mishra TS, Sinha M. Transmesenteric Internal Abdominal Hernia: Multi-detector row computed tomography findings. Sultan Qaboos Univ Med J 2021; 21:502-503. [PMID: 34522423 PMCID: PMC8407917 DOI: 10.18295/squmj.4.2021.025] [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: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arshdeep Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tushar S Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mithilesh Sinha
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Islam S, Shah AN, Dial S, Mahabir A, Harnarayan P, Naraynsingh V. Congenital Dual Internal Hernias Causing Small Bowel Obstruction in a Man with no Prior Surgical History: A Report of a Very Rare Case. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932132. [PMID: 34255765 PMCID: PMC8286804 DOI: 10.12659/ajcr.932132] [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] [Indexed: 11/10/2022]
Abstract
Patient: Male, 51-year-old Final Diagnosis: Congenial dual internal hernia with small bowel obstruction Symptoms: Abdominal pain • vomiting • constipation Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Shariful Islam
- Department of General Surgery, San Fernando Teaching Hospital (SFTH, SWRHA), San Fernando, Trinidad and Tobago.,Department of Clinical Surgical Science, University of West Indies, St. Augustine, Trinidad and Tobago
| | - Aneela N Shah
- Department of General Surgery, San Fernando Teaching Hospital (SFTH, SWRHA), San Fernando, Trinidad and Tobago.,Department of Clinical Surgical Science, University of West Indies, St. Augustine, Trinidad and Tobago
| | - Sarah Dial
- Department of General Surgery, San Fernando Teaching Hospital (SFTH, SWRHA), San Fernando, Trinidad and Tobago.,Department of Clinical Surgical Science, University of West Indies, St. Augustine, Trinidad and Tobago
| | - Avidesh Mahabir
- Department of General Surgery, San Fernando Teaching Hospital (SFTH, SWRHA), San Fernando, Trinidad and Tobago
| | - Patrick Harnarayan
- Department of General Surgery, San Fernando Teaching Hospital (SFTH, SWRHA), San Fernando, Trinidad and Tobago.,Department of Clinical Surgical Science, University of West Indies, St Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of General Surgery, San Fernando Teaching Hospital (SFTH, SWRHA), San Fernando, Trinidad and Tobago
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31
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Bensaad A, Habi J, El Aidaoui K, Fadil A, Sair K. A Fatal Case of Strangulated Pericecal Hernia. Cureus 2021; 13:e16097. [PMID: 34367751 PMCID: PMC8330507 DOI: 10.7759/cureus.16097] [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: 07/01/2021] [Indexed: 11/05/2022] Open
Abstract
Pericecal hernia, a subtype of internal hernia, is a rare and unusual cause of small-bowel obstruction (SBO). We report the case of a pericecal hernia in an 80-year-old woman who presented to the emergency department with symptoms of SBO. She experienced colicky diffuse abdominal pain associated with vomiting and obstipation for over five days. Abdominal examination showed rebound tenderness in the right iliac fossa without any mass palpation. Computed tomography noted a "sac-like" structure in the right iliac fossa with dilated and ischemic small-bowel loops within. Exploratory laparotomy showed strangulated pericecal hernia and non-viable small bowel loops in the inferior ileocecal recess. Extensive resection and defect repair followed by small-bowel end-to-end primary anastomosis was made. After two days of ICU admission, patient died from septic shock. This case report highlights the need for prompt diagnosis, followed by surgical intervention to lower mortality of SBO of internal hernia origin, especially in cases where no previous surgery is noted.
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Affiliation(s)
- Ahmed Bensaad
- General Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Jihane Habi
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Karim El Aidaoui
- Intensive Care Unit, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Abdelaziz Fadil
- Emergency Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Khalid Sair
- General Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
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32
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Zhang Z, Hu G, Ye M, Zhang Y, Tao F. A strangulated internal hernia beneath the left external iliac artery after radical hysterectomy with laparoscopic pelvic lymphadenectomy: a case report and literature review. BMC Surg 2021; 21:273. [PMID: 34059048 PMCID: PMC8166092 DOI: 10.1186/s12893-021-01249-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/16/2021] [Indexed: 12/27/2022] Open
Abstract
Background Ileum obstruction due to internal hernia beneath external iliac artery after pelvic lymph node dissection (PLND) is extremely rare. We reported a case of acute strangulated internal hernia between the left external iliac artery and psoas major as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy. Case presentation A 46-year-old woman, who with histories of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and PLND 9 years ago for the cervical malignant tumor, open appendectomy 18 years ago, visited our hospital complaining of aggravated left lower abdominal pain, bloating, nausea and vomiting from few hours ago. Left abdomen distention, tympanitic with rebound tenderness and muscular tension was detected during physical examinations. Accompanying with elevated inflammatory markers and mild intestinal dilatation showed in lab results and contrast-enhanced computed tomography (CT) respectively. After carefully reading the CT images, a small bowel was found between the left external iliac artery (EIA) and the psoas major, combined with the patient's surgical history, we suspected it might be internal hernia. Eventually, the emergency laparoscopic laparotomy confirmed our conjecture, the gap between the iliac vessels and the psoas major was closed with an absorbable suture, the patient was discharged on the fourth postoperative day. Conclusion Primary closure of peritoneal fissue maybe an effective measure to potentially prevent internal hernia. The choice of surgical approach for pelvic tumors still needs further exploration but faster diagnosis and immediate laparotomy might promise a better prognosis.
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Affiliation(s)
- Zhenxing Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000, China
| | - Gengyuan Hu
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000, China.
| | - Minfeng Ye
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000, China
| | - Yu Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000, China
| | - Feng Tao
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000, China
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33
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Zhu T, Lou Q, Ma X, Chen T, Qiu L, Chen G. Internal hernia caused by the appendix adhering to the right ovary: a case report. Am J Transl Res 2021; 13:3864-3867. [PMID: 34017578 PMCID: PMC8129242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
Internal hernias are a rare condition and sometimes life-threatening, and they need an emergency exploratory laparotomy. Appendicectomy for chronic appendicitis is controversial. Without timely treatment, chronic appendicitis may develop into a ruptured appendix and an infection that spreads to other parts of the body, and other serious complications. Here we report the case of 48-year-old female who had intestinal ischemia secondary to internal hernia caused by the appendix adhering to the right ovary. Her medical history indicated a chronic, right lower abdominal pain for three years.
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Affiliation(s)
- Tieming Zhu
- Department of General Surgery, Zhejiang Xiaoshan HospitalHangzhou, Zhejiang Province, China
| | - Qiuyue Lou
- Department of Health Education, Zhuji People’s Hospital of Zhejiang ProvinceShaoxing, Zhejiang Province, China
| | - Xueqiang Ma
- Department of General Surgery, Zhuji People’s Hospital of Zhejiang ProvinceShaoxing, Zhejiang Province, China
| | - Tiejiong Chen
- Department of General Surgery, Zhuji People’s Hospital of Zhejiang ProvinceShaoxing, Zhejiang Province, China
| | - Leiyu Qiu
- Department of Radiology, Zhuji People’s Hospital of Zhejiang ProvinceShaoxing, Zhejiang Province, China
| | - Ganghong Chen
- Department of General Surgery, Zhuji People’s Hospital of Zhejiang ProvinceShaoxing, Zhejiang Province, China
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34
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Reyes N, Smith LE, Bruce D. Strangulated internal hernia due to defect in broad ligament: a case report. J Surg Case Rep 2020; 2020:rjaa487. [PMID: 33294168 PMCID: PMC7700802 DOI: 10.1093/jscr/rjaa487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Small bowel obstruction is a relatively common disease process accounting for up to 16 percent of surgical admissions and more than 300,000 operations annually in the United States. Approximately 5–8 percent of small bowel obstructions can be attributed to internal hernias. A slightly lower percentage, roughly 4–7 percent, of these internal hernias are noted to originate from a defect in the broad ligament of the uterus. A majority of broad ligaments defects causing a small bowel obstruction are not diagnosed preoperatively due to the equivocal imaging findings as well as the infrequency of this etiology. To date, there are very few case reports describing this disease process. This case report describes a 70-year-old female who was found to have a defect in her broad ligament causing a small bowel obstruction leading to subsequent strangulated bowel.
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Affiliation(s)
- Nicole Reyes
- Grandview Medical Center, Department of Surgery, Dayton, OH, USA
| | - Lauren E Smith
- Grandview Medical Center, Department of Surgery, Dayton, OH, USA
| | - David Bruce
- Grandview Medical Center, Department of Surgery, Dayton, OH, USA
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Bollampally AR, Dhanapal B, Mohammed FH. Right Paraduodenal Hernia: A Rare Cause of Small Bowel Strangulation. Cureus 2020; 12:e11807. [PMID: 33409052 PMCID: PMC7779179 DOI: 10.7759/cureus.11807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Internal hernias are a rare cause of intestinal obstruction. Among the internal hernias, left paraduodenal hernia is the most typical type followed by the right paraduodenal hernia. It is impossible to make a clinical diagnosis of internal hernia, as there are no specific symptoms or physical signs. A high degree of suspicion is required, and an accurate diagnosis can be made using cross-sectional imaging of the abdomen like a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scan. In this case report, we present our experience in managing a patient who had a right paraduodenal hernia with small bowel strangulation. We present this case report to highlight the importance of considering internal hernias like right paraduodenal hernia in the differential diagnosis of intestinal obstruction.
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Affiliation(s)
| | - Baskaran Dhanapal
- Surgery, Apollo Institute of Medical Sciences and Research, Hyderabad, IND
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Pan T, Wang H, Liu K, Chen XZ, Zhang WH, Chen XL, Yang K, Zhang B, Zhou ZG, Hu JK. Closure of Petersen's defect in gastrectomy for gastric cancer: an interrupted time series analysis from a high-volume institution in China. Langenbecks Arch Surg 2020; 406:427-436. [PMID: 33151418 PMCID: PMC7936939 DOI: 10.1007/s00423-020-02019-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Petersen's hernia (PH) is a serious complication after gastrectomy for gastric cancer. The aim of this study was to investigate whether closure of Petersen's defect (PD) can decrease the rates of PH and suspected Petersen's hernia (SPH). METHODS Patients who underwent gastrectomy with PD were enrolled. From January 2014 to January 2017, we performed gastrectomy without PD closure (non-closure group). From February 2017 to June 2018, we closed PDs during gastrectomy (closure group). The rates of PH and SPH were compared between the two groups. The last follow-up was updated in August 2020. RESULTS Among a total of 1213 patients, 12 patients (1.0%) developed PH, and 23 patients (1.9%) developed SPH. The rate of PH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 11/828, 1.3%, p = 0.042, log-rank test). The rate of SPH in the closure group was significantly lower than that in the non-closure group (1/385, 0.3% versus 22/828, 2.7%, p = 0.008, log-rank test). Non-closure of PD was a risk factor for PH and SPH (odds ratio (OR) 7.72, 95% CI 1.84-32.35, p = 0.006). CONCLUSIONS PD closure is recommended after gastrectomy for gastric cancer, as the rates of PH and SPH were significantly decreased.
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Affiliation(s)
- Tao Pan
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Hui Wang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kai Liu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xiao-Long Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kun Yang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 GuoXue Xiang Street, Chengdu, 610041, Sichuan Province, China.
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37
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Ultrasound diagnosis of acute appendicitis complicating De Garengeot's hernia. J Ultrasound 2020; 24:205-209. [PMID: 32356219 DOI: 10.1007/s40477-020-00466-7] [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: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
De Garengeot's hernia is a rare condition defined by the herniation of the vermiform appendix within a femoral hernia sac. We report a case of an 80-year-old woman admitted to our emergency department complaining of pain in the right groin. This symptomatology, present for 2 days, increased in the following 12 h. Ultrasonography (US) and contrast-enhanced computed tomography (CECT) were performed, which showed the herniation of the vermiform appendix in the femoral hernia sac. Doppler ultrasonography (DUS) and CECT were the fundamental imaging investigations for this diagnosis. The management of De Garengeot's hernia is surgical through herniorrhaphy, which makes it possible to repair the femoral hernia and perform an appendicectomy in case of appendicitis.
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Pacheco AC, Jervis MJ, Pimenta J, Escrevente R, Caratão F. Internal double omental hernia: a rare cause of acute abdomen. J Surg Case Rep 2020; 2020:rjaa038. [PMID: 32153764 PMCID: PMC7054200 DOI: 10.1093/jscr/rjaa038] [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: 01/27/2020] [Revised: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 12/25/2022] Open
Abstract
Small bowel obstruction is one of the most common causes for acute abdominal pain leading to surgical admissions, occurring most frequently due to postoperative adhesions. Although less common, internal hernia is also a possible etiology, in which a delay on its therapy may lead to a not so dismal morbidity and mortality. Here, we report the case of a 24 year old Caucasian man that was admitted in our emergency department with an inaugural episode of sudden-onset epigastric pain associated with vomiting. After observation and diagnostic workup, the patient underwent urgent laparotomy that revealed an ischemic small bowel due to a double omental hernia, being successfully treated without enteric resection.
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Affiliation(s)
- André C Pacheco
- General Surgery Department, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Maria J Jervis
- General Surgery Department, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Joana Pimenta
- General Surgery Department, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Ricardo Escrevente
- General Surgery Department, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Fátima Caratão
- Head of General Surgery Department, Hospital José Joaquim Fernandes, Beja, Portugal
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Abstract
Teaching Point: The typical CT finding of internal supravesical hernia is a herniated and dilated bowel loop beneath a compressed urinary bladder.
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40
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Liu Z, He L, Jiao Y, Xu Z, Suo J. An extremely rare case of lesser omental hernia in an elderly female patient following total colectomy. BMC Surg 2020; 20:14. [PMID: 31948420 PMCID: PMC6966879 DOI: 10.1186/s12893-019-0665-7] [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: 03/14/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022] Open
Abstract
Background An intro-abdominal hernia through the lesser omentum is a rare but severe condition that can cause intestinal obstruction and other life-threating complications. Until now, only a handful of cases have been reported worldwide. The diagnosis of lesser omental hernia remains challenging for emergency surgeons because of the unspecific symptoms. Therefore, there is a need for a better understanding of the characteristics of this condition. Case presentation In this report, we described the case of a 73-year-old female patient who was diagnosed with a lesser omental hernia caused by previous total colectomy. The patient underwent emergency surgery, and the intraoperative findings revealed a 200-cm segment of the small intestine was herniated through a defected lesser omentum (approximately 3 × 4 cm) from the lesser retrogastric curvature of the stomach. Besides, we summarize the specific abdominal computed tomography (CT) findings of lesser omental hernia by reviewing the literature. Conclusion The lesser omental hernia is extremely rare but can cause serious complications. The cause of lesser omental hernia can be congenital or acquired. Careful examination of the small omentum before the closure of the abdomen is expected to reduce the occurrence of these abdominal surgery-associated complications. The specific features of abdominal CT in cases of lesser omental hernia, which are summarized in this article, can help other clinicians to obtain accurate diagnoses of lesser omentum hernia in the future.
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Affiliation(s)
- Zhicheng Liu
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, 71 Xinmin Ave., Changchun, 130021, Jilin, China
| | - Liang He
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, 71 Xinmin Ave., Changchun, 130021, Jilin, China
| | - Yan Jiao
- Department of Hepatobiliary and pancreatic Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Zhonghang Xu
- Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jian Suo
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, 71 Xinmin Ave., Changchun, 130021, Jilin, China.
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