Results of a Laparoscopic Approach for the Treatment of Acute Small Bowel Obstruction due to Adhesions and Internal Hernias

Internal hernia means a protrusion into pouches or openings in the peritoneum or mesentry in contrast to the hernias through defects in the retaining walls of the abdomen. Internal hernias are of many varieties with different classifications and can be congenital or acquired post-surgery. We present a case of a 55 year old female who presented with symptoms of acute small bowel obstruction with previous history of exploratory laparotomy 20 years back for reasons not known to her. Routine blood investigations, chest and abdomen skiagram and a CECT abdomen were performed (which gave no significant clue to diagnosis) and after a failed conservative trial patient was taken for exploration. Intra operatively a gangrenous loop of small bowel was found herniating through a band between the small bowel mesentry and the sigmoid mesocolon, forming a closed loop obstruction. Resection anastomosis of the gangrenous segment along with band transection was performed. The post-operative course was uneventful. Internal herniation as a cause of bowel obstruction should always be kept in mind as a differential.

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OV13 LAPAROSCOPIC APPROACH IN EMERGENCY HERNIA SURGERY: MANAGEMENT OF ACUTE SMALL BOWEL OBSTRUCTION SECONDARY TO STRANGULATED OBTURATOR HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab396.064 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Javed Latif ◽

Imran Bhatti ◽

Altaf Awan

Keyword(s):

Small Bowel ◽

Minimally Invasive ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Laparoscopic Approach ◽

Obturator Hernia ◽

Linear Segment ◽

Invasive Approach ◽

Preperitoneal Approach ◽

Acute Small Bowel Obstruction

Abstract Aim Acute small bowel obstruction secondary to strangulated obturator hernia is a rare condition, with high rates of morbidity and mortality in the absence of prompt diagnosis and intervention. We aim to describe a case with the above presentation, managed using a minimally-invasive approach with positive outcomes. Material and Methods We describe a case of an 82-year-old female who presented with acute small bowel obstruction secondary to strangulated obturator hernia on cross-sectional imaging. Results The patient underwent emergency surgery using laparoscopic approach for repair of obturator hernia and assessment of obstructed small bowel. Our approach involved identification and reduction of small bowel loop. A transabdominal preperitoneal approach was made to obturator hernia and ischaemic sac was reduced followed by closure of defect with a plug of biologic mesh. A linear segment of ischaemic small bowel was oversewn. Total operative time was 90 minutes. Conclusions Minimally-invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case demonstrates the feasibility of laparoscopy for small bowel obstruction secondary to strangulated obturator hernia in the acute setting, requiring advanced laparoscopic skill as demonstrated in this video.

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THREE CASES OF BOWEL OBSTRUCTION BY BROAD LIGAMENT HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab160.017 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

M Soto Dopazo ◽

E Pérez Prudencio ◽

A Arango Bravo ◽

C Nuño Iglesias ◽

C Mateos Palacios ◽

...

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Broad Ligament ◽

Intestinal Resection ◽

Laparoscopic Approach ◽

Exploratory Laparotomy ◽

X Rays ◽

Intestinal Necrosis ◽

Urgent Surgery ◽

Internal Hernias

Abstract INTRODUCTION Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs. MATERIAL AND METHODS We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction. RESULTS We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications. DISCUSSION Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.

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Acute small bowel obstruction in a girl, caused by a jejunal bezoar composed of textile fibers

Journal of Pediatric Surgery Case Reports ◽

10.1016/j.epsc.2013.05.017 ◽

2013 ◽

Vol 1 (8) ◽

pp. 192-193

Author(s):

S. Zwaveling ◽

D.C. van der Zee

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Textile Fibers ◽

Acute Small Bowel Obstruction

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An interesting case of left paraduodenal hernia.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4648 ◽

2021 ◽

Vol 28 (05) ◽

pp. 755-758

Author(s):

Sahar Saeed ◽

Abeera Butt ◽

Syed Asghar Naqi ◽

Muhammad Mohsin Ali

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Interesting Case ◽

Paraduodenal Hernia ◽

Absorbable Suture ◽

Internal Hernias ◽

Plain Abdominal Radiography ◽

History Of ◽

Operative Recovery

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

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