Concurrent Spigelian and Grynfeltt-Lesshaft Hernias

2021 ◽  
pp. 000313482110562
Author(s):  
Ryan M. Huttinger ◽  
Matthew S. Kazaleh ◽  
Dylan J. Skinner ◽  
Marsha C. Nelson
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Synthetic Mesh ◽  
Accurate Diagnosis ◽  
Spigelian Hernia ◽  
Lower Quadrant ◽  
Superior Lumbar Triangle ◽  
Lumbar Triangle ◽  
Right Lower Quadrant

Only 0.12% to 2% of diagnosed hernias are Spigelian type. Even less frequently encountered—Grynfeltt-Lesshaft hernias—hernias have unknown incidence. A Spigelian hernia is encountered along the Spigelian fascia and Grynfeltt-Lesshaft hernias are bounded by the superior lumbar triangle. These unique hernias can both be intermuscular, given their anatomical borders which allow concealment and preclusion of accurate diagnosis. Here, an 86-year-old male presented with symptoms consistent with small bowel obstruction. On physical exam, a right lower quadrant hernia and right posterior flank mass were appreciated. Computed tomography revealed obstruction secondary to bowel incarceration within Spigelian hernia and additional Grynfeltt-Lesshaft hernia. The patient underwent reduction and repair of Spigelian hernia with synthetic mesh, while repair of asymptomatic hernia was deferred. These unusual hernias are difficult to distinguish, given their negligible occurrence and unreliable exam findings. Clinicians must remain cognizant of their features to aid in diagnosis and mitigate potential sequelae.

scholarly journals SMALL BOWEL OBSTRUCTION SECONDARY TO OBTURATOR HERNIA: A PRE-OPERATIVE DIAGNOSIS AT COMPUTED TOMOGRAPHY

2021 ◽  
Vol 6 (1) ◽  
pp. 46-49
Author(s):  
Marlina Tanty Ramli ◽  
Mohd Shukry Mohd Khalid ◽  
Kartini Rahmat
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Elderly Patients ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Obturator Hernia ◽  
Uneventful Recovery ◽  
Presenting Symptoms

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

scholarly journals Intraluminal Meckel’s Duplication Cyst Causing Bowel Obstruction in an Infant: A Role for Laparotomy

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Mitchell R. Ladd ◽  
Alejandro V. Garcia ◽  
Derek B. Allison ◽  
Jeffrey R. Lukish
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Ileocecal Valve ◽  
Signs And Symptoms ◽  
Duplication Cyst ◽  
Ectopic Gastric Mucosa ◽  
Lower Quadrant ◽  
Intraluminal Mass ◽  
Enteric Duplication ◽  
Right Lower Quadrant

This report describes a two-month-old girl who presented with signs and symptoms of a distal small bowel obstruction. She underwent an abdominal ultrasound that revealed a right lower quadrant cystic mass. A Technetium-99 scan revealed increased activity in the right lower quadrant consistent with a Meckel’s diverticulum. Following a nondiagnostic laparoscopic evaluation, a laparotomy was performed to allow direct palpation of the small bowel and colon. Direct palpation of the ileum revealed a soft intraluminal mass at the ileocecal valve. The child underwent an ileocecectomy and anastomosis incorporating the intraluminal mass. Pathologic analysis revealed an intraluminal enteric duplication cyst containing ectopic gastric mucosa. This case represents the first report of such an entity in an infant. A discussion of the diagnostic and therapeutic aspects of the case and enteric duplication cysts is provided.

scholarly journals Small bowel transit of a bran meal residue in humans: sieving of solids from liquids and response to feeding

Gut ◽  
1998 ◽  
Vol 42 (5) ◽  
pp. 685-689 ◽  
Author(s):  
J M Hebden ◽  
P E Blackshaw ◽  
A C Perkins ◽  
M D’Amato ◽  
R C Spiller
Keyword(s):  
Gastric Emptying ◽  
Small Bowel ◽  
Small Bowel Transit ◽  
Motor Patterns ◽  
Solid Meal ◽  
Lower Quadrant ◽  
Distal Small Bowel ◽  
Proximal Small Bowel ◽  
Indium 111 ◽  
Right Lower Quadrant

Background—Ileal motor patterns are adapted to the propulsion of viscous meal residue, such as bran, which accumulates in the distal ileum postprandially.Aims—To examine the effects of a second liquid/solid meal on ileal emptying.Subjects and methods—Eleven healthy fasting subjects consumed a 1.47 MJ pancake containing 15 g bran and 5 MBq Technetium-99m labelled amberlite resin (meal A). Gastric emptying and transit through the left upper quadrant (proximal) and right lower quadrant (distal) small bowel regions and colon were assessed scintigraphically. Transit was compared with and without a second Indium-111 liquid/solid DTPA labelled 2.28 MJ meal (B) given three hours after the first meal.Results—Gastric emptying of meal A was slower than meal B (the time for 50% of the activity to leave the stomach (T50) being 113 (11) minutes versus 48 (3) minutes respectively, p<0.01, n=11). Both meals passed rapidly through the proximal small bowel (T50 meal A = 57 (14) minutes versus T50 meal B = 42 (11) minutes). Transit of meal A through the distal small bowel was much slower (T50 more than 390 minutes versus 176 (29) minutes for meal B, p<0.01), resulting in meal B overtaking meal A and entering the colon earlier. Ingestion of the second meal (B) resulted in significantly less meal A marker entering the colon (5 (3)%) at 11 hours than when meal A was taken alone (18 (4)%) (p<0.05, n=8).Conclusions—The distal small bowel selectively retains bran, allowing liquid phase markers through to the colon. Consuming a second liquid/solid meal does not stimulate ileal transit of bran which seems to be propelled quicker by fasting motor patterns.

Computed tomography findings of internal hernia after gastric bypass that may precede small bowel obstruction

Hernia ◽  
2015 ◽  
Vol 20 (3) ◽  
pp. 471-477 ◽  
Author(s):  
J. Park ◽  
M. Chung ◽  
J. Teixeira ◽  
J. Baer ◽  
D. Frager
Keyword(s):  
Computed Tomography ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Internal Hernia
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