Case Report: 7-Year-Old Boy with Incarcerated Internal Hernia Leading to Extensive Intestinal Necrosis Due to a Large Congenital Mesenteric Defect

AbstractWe present a case of a 7-year-old boy with acute abdominal symptoms initially misdiagnosed as constipation. Delayed imaging diagnostics revealed an ileus with contorted small intestine, so laparotomy was indicated. An acute bowel obstruction was found based on an incarcerated internal hernia. Small and large bowel segments were incarcerated into a large mesenteric defect leading to extended intestinal necrosis. About 30 cm of necrotic small bowel and 15 cm of large intestine were resected, two primary anastomoses were performed. The mesenteric defect was closed with two running sutures. The boy’s clinical outcome was very good. Two aspects are discussed: the initial clinical misdiagnosis of acute bowel obstruction in a child leading to a delay of diagnostics and therapy on the one hand and the origin of mesenteric defects on the other. In children with abdominal pain, ultrasound must be performed as soon as possible and pediatric surgeons have to be involved early. There should be an awareness of the fact, that mesenteric defects and other congenital malformations can occur more often than we suspect it. In the case of an internal hernia, a misjudgement of the clinical condition may be very harmful for the patient and can lead to a short bowel syndrome or even death.

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Strangulated Bowel Obstruction due to a Mesenteric Defect Internal Hernia after Laparoscopic Sigmoid Colon Resection

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.72.165 ◽

2019 ◽

Vol 72 (4) ◽

pp. 165-170

Author(s):

Daishi Naoi ◽

Koji Koinuma ◽

Hisanaga Horie ◽

Gaku Ota ◽

Ai Sadatomo ◽

...

Keyword(s):

Sigmoid Colon ◽

Bowel Obstruction ◽

Internal Hernia ◽

Colon Resection ◽

Mesenteric Defect

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Internal Hernia in Pregnant Woman due to Congenital Transmesenteric Defect

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.5.4116 ◽

2021 ◽

Vol 37 (5) ◽

Author(s):

Yuansheng Xu ◽

Yi Wang ◽

Jinyan Fang

Keyword(s):

Abdominal Pain ◽

Pregnant Woman ◽

Small Bowel ◽

Bowel Obstruction ◽

Internal Hernia ◽

Early Stage ◽

Left Kidney ◽

Exploratory Laparotomy ◽

First Trimester ◽

Mesenteric Defect

Congenital transmesenteric hernias are uncommon and are a rare cause of bowel obstruction, which is even rarer in pregnant woman. Because of the lack of specific symptoms or reliable sensitive markers, it is difficult to diagnose internal hernia at early stage, therefore resulting in the delay of surgical intervention and a high mortality rate, especially in pregnant woman. We report a case in which a woman presenting at 16 weeks gestation was admitted with symptoms of nausea, vomiting and left upper abdominal pain similar to her first-trimester morning sickness. Nephrolithiasis of the left kidney detected by ultrasound may lead to early incorrect diagnosis. Due to the patient`s concern about known adverse effects of ionizing radiation on the fetus, computed tomography was postponed until abdominal pain worsened, coffee color gastric contents vomited and anus stopped exhaust and defecation 12 hours later. Low dose CT plain scan showed features of small bowel obstruction by an internal hernia. Emergency exploratory laparotomy revealed a mesenteric defect of the left colon with a 30 cm long jejunal herniating distal to 10 cm of the ligament of Treitz. The involved small bowel was strangulated and gangrened, necrotic segmental resection and end to end anastomosis were performed subsequently, and the mesenteric defect was then successfully repaired with sutures. doi: https://doi.org/10.12669/pjms.37.5.4116 How to cite this:Yuansheng X, Yi W, Jinyan F. Internal Hernia in Pregnant Woman due to Congenital Transmesenteric Defect. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4116 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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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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Strangulated internal hernia through the lesser omentum with intestinal necrosis: a case report

Sao Paulo Medical Journal ◽

10.1590/s1516-31802002000300006 ◽

2002 ◽

Vol 120 (3) ◽

pp. 84-86 ◽

Cited By ~ 15

Author(s):

Gustavo Gibin Duarte ◽

Belchor Fontes ◽

Renato Sérgio Poggetti ◽

Marcos Roberto Loreto ◽

Paulo Motta ◽

...

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Clinical Manifestations ◽

Acute Intestinal Obstruction ◽

Main Task ◽

Intestinal Necrosis ◽

Lesser Omentum ◽

Lesser Sac ◽

Internal Hernias

CONTEXT: Internal hernias account for only 0.2 to 0.9% of the cases of intestinal obstruction. They do not have specific clinical manifestations, and are usually diagnosed during laparotomy for acute intestinal obstruction. Internal hernias through the lesser omentum are extremely rare. CASE REPORT: We report here the case of a 36-year-old patient who underwent exploratory laparotomy for acute intestinal obstruction. An internal hernia through the lesser omentum was found, with a strangulated ileal segment passing through the perforation into an abscess within the lesser sac. The surgical procedures included ileal resection, primary anastomosis, abscess removal, and placement of a drain in the lesser sac. The patient was reoperated 6 days later for abdominal sepsis; a lesser sac abscess was removed and the abdominal incision was left open. The patient stayed in the Intensive Care Unit for 15 days, and eventually left the hospital on the 28th post-admission day, with complete recovery thereafter. CONCLUSION: The early diagnosis of acute intestinal obstruction and immediate indication for laparotomy is the main task of the surgeon when faced with a case of acute abdomen with a hypothesis of internal hernia, so as to minimize severe postoperative complications, as illustrated by the present case.

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Mesenteric Defect with Internal Herniation: A Rare Cause of Bowel Obstruction in Newborn

Fetal and Pediatric Pathology ◽

10.3109/15513815.2015.1029658 ◽

2015 ◽

Vol 34 (4) ◽

pp. 207-211 ◽

Cited By ~ 1

Author(s):

Hakim Adnen ◽

Borgi Aida ◽

Belhadj Serra ◽

Ghali Narjess ◽

Hamdi Asma ◽

...

Keyword(s):

Bowel Obstruction ◽

Mesenteric Defect ◽

Internal Herniation

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Small Bowel Obstruction After Laparoscopic Gastric Bypass with Nonclosure of Mesenteric Defects

JSLS Journal of the Society of Laparoendoscopic Surgeons ◽

10.4293/jsls.2014.00257 ◽

2015 ◽

Vol 19 (1) ◽

pp. e2014.00257 ◽

Cited By ~ 4

Author(s):

Benjamin Clapp

Keyword(s):

Gastric Bypass ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Laparoscopic Gastric Bypass ◽

Mesenteric Defects

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Preventing Peterson’s space Hernia Using a Bio Synthetic Mesh

10.21203/rs.2.17099/v1 ◽

2019 ◽

Author(s):

Adam Peter Skidmore ◽

Edo O Aarts

Keyword(s):

Internal Hernia ◽

Controlled Trial ◽

Gastric Pouch ◽

Synthetic Mesh ◽

First Year ◽

Absorbable Suture ◽

Private Hospitals ◽

Randomized Controlled ◽

Mesenteric Defects ◽

Ideal Technique

Abstract Introduction Up to 30% of all Bariatric procedures performed worldwide still are Roux-en-Y Gastric Bypasses (RYGB). Internal hernia’s occur when small bowel herniates into the intermesenteric spaces created when the roux limb is mobilised for anastomosis to the gastric pouch. To prevent internal hernia’s to occur many surgeons nowadays close the mesenteric defects during primary RYGB. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. However the technique of closure seems to be related to these reduced internal hernia risks outcomes while for example closure with staples does reduce the amount of internal hernia’s but in a much lesser extent. Setting Two large private hospitals specialized in bariatric surgeryMethods All patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In the first year Peterson’s space was closed using glue, the years hereafter it was closed using a double layered non absorbable suture combined with a piece of glued BIO Mesh.Results The first group of glued RYGB patients showed 15% of patients with an internal hernia through Peterson’s space compared to 0% of patients (p<0.001) who had a combined sutured and BIO Mesh Closure of their Peterson’s space defect. Although an ideal technique for Peterson’s space, it led to 1% of entero-enterostomy kinking due to firm adhesions.Conclusion Closing this defect with clips or sutures partially reduces the chances on herniation, but not completely. Gluing this defect is not beneficial, but placing a BIO Mesh in Peterson’s space is a promising new technique to induce local adhesions. It is at least safe, effective and led to a complete reduction of Peterson’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture would give more insights in which is the optimal closure technique.

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Superior Mesenteric Venous Thrombosis after Laparoscopic Exploration for Small Bowel Obstruction

Case Reports in Surgery ◽

10.1155/2013/952383 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Hideki Katagiri ◽

Shozo Kunizaki ◽

Mayu Shimaguchi ◽

Yasuo Yoshinaga ◽

Yukihiro Kanda ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Abdominal Surgery ◽

Venous Thrombosis ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Anticoagulation Therapy ◽

Mesenteric Venous Thrombosis ◽

Laparoscopic Exploration ◽

Abdominal Symptoms

Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms.

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