scholarly journals 559 One Mesenteric Defect, Two Segments of Colon, A Number of Surgical Strategies! A Rare Case of An Internal Hernia Causing Bowel Ischemia

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Devani ◽  
N Al-Saadi ◽  
D Bowrey
Keyword(s):  
Small Bowel ◽  
Sigmoid Colon ◽  
Internal Hernia ◽  
Laparoscopic Approach ◽  
Signs And Symptoms ◽  
High Morbidity ◽  
Sigmoid Colectomy ◽  
Open Approach ◽  
Mesenteric Defect ◽  
Surgical Strategies

Abstract Internal hernias due to mesenteric defects are a rare cause of bowel obstruction, but once present their complications are associated with a high morbidity and mortality. We present the case of a 24-year-old patient who presented to the emergency department with signs and symptoms of an acute abdomen. Following surgical review, taking into consideration the patient’s clinical, biochemical, and radiological findings, the patient was taken for immediate emergency surgical exploration. A laparoscopic approach was initially taken, which revealed dilated and ischemic colon, and therefore an open approach was then adopted. Operative findings included a very mobile caecum and proximal ascending colon which had herniated through a defect in the small bowel mesentery, the sigmoid colon had subsequently become incarcerated by the caecum and small bowel too. Both the ascending and sigmoid colon had become ischemic. A number of surgical strategies were considered, and given the patients age it was decided to preserve as much normal bowel as possible. Thus, a right hemi- and sigmoid colectomy were performed with an ileo-transverse anastomosis and formation of an end colostomy. In this case, radiological diagnosis pointed to a suspicion of an internal hernia, and operative diagnosis highlighted a rare mesenteric defect causing herniation and subsequent ischemia. Relying on the patient’s clinical condition and an early decision for surgical intervention resulted in a positive outcome for outpatient. The patient made a good recovery following the bowel preserving surgery.

A mesenteric defect causing internal herniation and ischaemia of both the ascending and sigmoid colons, treated with a bowel preserving surgery

2021 ◽  
Vol 14 (6) ◽  
pp. e242031
Author(s):  
Nina Al-Saadi ◽  
Pooja Devani ◽  
David I Hunter ◽  
David J Bowrey
Keyword(s):  
Small Bowel ◽  
Sigmoid Colon ◽  
Positive Outcome ◽  
High Morbidity ◽  
Surgical Strategies ◽  
Internal Hernias ◽  
History Of ◽  
Early Decision ◽  
Operative Findings ◽  
Mesenteric Defects

Internal hernias due to mesenteric defects are a rare cause of bowel obstruction, but once present their complications are associated with a high morbidity and mortality. We present the case of a 24-year-old patient who presented to the emergency department with a 6-hour history of abdominal pain. Initial surgical review, taking into consideration the patient’s clinical, biochemical and radiological findings, led to the patient being taken for immediate surgical exploration. Operative findings included a very mobile caecum and proximal ascending colon which had herniated through a defect in the small bowel mesentery, the sigmoid colon had subsequently become incarcerated by the caecum and small bowel too. Both the ascending and sigmoid colon had become ischaemic. Due to the early decision for surgical intervention, we were able to consider a number of surgical strategies, and the surgery led to a positive outcome for our patient.

Small Bowel Sigmoid Colon Fistula Resulting from Diverticulitis Causing an Internal Hernia

2020 ◽  
Vol 24 (11) ◽  
pp. 2688-2689
Author(s):  
Kortney Robinson ◽  
Sean Hersey ◽  
Nisha Narula
Keyword(s):  
Small Bowel ◽  
Sigmoid Colon ◽  
Internal Hernia ◽  
Colon Fistula

Laparoscopic removal of mesh migrating into the sigmoid colon after totally extraperitoneal (TEP) laparoscopic inguinal hernia repair with positive faecal occult blood test

2021 ◽  
Vol 14 (2) ◽  
pp. e237167
Author(s):  
Sujin Gang ◽  
Min Jung Kim ◽  
Ji Won Park ◽  
Seung-Bum Ryoo
Keyword(s):  
Inguinal Hernia ◽  
Sigmoid Colon ◽  
Blood Test ◽  
Laparoscopic Approach ◽  
Occult Blood ◽  
Faecal Occult Blood Test ◽  
Open Approach ◽  
Occult Blood Test ◽  
Totally Extraperitoneal ◽  
Abdominal Approach

A 76-year-old man was referred to our clinic after a foreign body seen in his sigmoid colon during a colonoscopy. He had undergone three operations for a left inguinal hernia within the previous 8 years, and the first procedure was a laparoscopic totally extraperitoneal approach. Four years later, removal of migrated and infected mesh was conducted by open approach. He then had a positive stool occult blood test for routine check-up 4 years after the remnant mesh removal. An ill-defined lesion was identified on colonoscopy. CT revealed a 2.7 cm diameter enhancing lesion in the sigmoid colon. Laparoscopic sigmoidectomy was performed, and remnant mesh fragment was found in the sigmoid colon and removed. The migrated mesh could not be wholly removed by open abdominal approach and the remnant mesh fragment migrated to sigmoid colon. It suggests the importance of a laparoscopic approach to remove the entire mesh.

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

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

scholarly journals Internal Hernia in Pregnant Woman due to Congenital Transmesenteric Defect

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.

scholarly journals Laparoscopic versus Open Surgery for Acute Adhesive Small-Bowel Obstruction: A Propensity Score–Matched Analysis

2016 ◽  
Vol 106 (1) ◽  
pp. 28-33 ◽  
Author(s):  
T. Hackenberg ◽  
P. Mentula ◽  
A. Leppäniemi ◽  
V. Sallinen
Keyword(s):  
Small Bowel ◽  
Propensity Score ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Open Surgery ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Adhesive Small Bowel Obstruction ◽  
Open Approach ◽  
Laparoscopic Adhesiolysis

Background and Aims: The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction. Material and Methods: Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters. Results: A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien–Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group ( p = 0.052). Twenty-five propensity score–matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score–matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score–matched open adhesiolysis groups (0% vs 4%, p = 0.31). Conclusion: Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.

scholarly journals P125 MANAGEMENT OF PERICAECAL HERNIA CAUSING SMALL BOWEL OBSTRUCTION IN THE EVOLVING ERA OF LAPAROSCOPY. A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Mohamed Salama ◽  
Mahmoud Salama ◽  
Abdulrahman Nasr ◽  
Himanshu Yadav ◽  
Babur Sami
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Internal Hernia ◽  
Laparoscopic Approach ◽  
Definitive Treatment ◽  
Ct Diagnosis ◽  
Rare Type ◽  
Minimal Invasiveness

Abstract Introduction “Internal hernias are an unusual cause of intestinal obstruction. Pericaecal hernias are an exceptionally rare type of internal hernia. Laparoscopy for small bowel obstruction was previously considered inappropriate. We present a case of Pericaecal hernia causing small bowel obstruction treated successfully with a laparoscopic approach.” Case-Report “64 year old man presented with abdominal pain, vomiting and constipation for 3 days, no previous surgery. Small bowel obstruction confirmed on PFA and CT. He was treated conservatively for 10 days without settling. A an exploratory laparoscopy revealed a Pericaecal hernia. This was reduced with gentle manoeuvre and the peritoneal folds were divided to prevent recurrence. Recovery was uneventful.” Discussion “Perioperative diagnosis of internal hernia is extremely difficult. Pericaecal hernia is an uncommon type of internal hernia. CT diagnosis of internal hernia remains difficult. Laparoscopy is a valuable tool for diagnosis and treatment with the advantage of minimal invasiveness. However, the laparoscopic manipulation of distended bowel loops remain controversial because of high risk of perforation, reduced space to work in the peritoneal cavity and requirement of advanced laparoscopic skills. Laparoscopic treatment of Pericaecal hernia was reported about 17 years ago but has since been reported more frequently and in recent years there is a move towards laparoscopic diagnosis and management of Pericaecal hernias.” Conclusions “CT diagnosis of internal hernia remains difficult. With the advent of minimal access surgery, diagnostic laparoscopy may be a safe and feasible modality to diagnose and deliver definitive treatment of small bowel obstruction secondary to Pericaecal hernia.”

scholarly journals Persistent descending mesocolon: Case report

2012 ◽  
Vol 140 (9-10) ◽  
pp. 637-640 ◽  
Author(s):  
Zoran Trebjesanin ◽  
Srdjan Babic ◽  
Goran Vucurevic ◽  
Petar Popov ◽  
Nenad Ilijevski ◽  
...  
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Abdominal Wall ◽  
Sigmoid Colon ◽  
Internal Hernia ◽  
Splenic Flexure ◽  
Clinical Symptoms ◽  
Embryological Development ◽  
Descending Colon ◽  
The Right

Introduction. Positional anomalies of the right half of the colon are quite common whereas positional anomalies of the left half of the colon are much less common because of embryological disorders during the period of the embryological development of that part of the bowel. The process of the fixation of the descending colon to the posterior abdominal wall can be absent. In that case, when the descending colon has a free descending mesocolon, it shows some degree of mobility. Case Outline. We are presenting an example of one of the anomalies, which is characterized by the persistent descending mesocolon, which extends from the splenic flexure or just below it to the sigmoid colon. The persistent descending mesocolon in our case contains or surrounds almost complete small bowel in a recess which is located laterally to the left of the midline. The content of this hernial sac simulates the symptoms of an internal hernia followed by clinical symptoms and roendgenographical signs. Conclusion. We are of the opinion that this anomaly is more common than some surveys of literature would suggest.

scholarly journals Comparison of defecatory function after laparoscopic total colectomy and ileorectal anastomosis versus a traditional open approach

2018 ◽  
Vol 100 (3) ◽  
pp. 235-239 ◽  
Author(s):  
MAS Khan ◽  
D Jayne ◽  
R Saunders
Keyword(s):  
Colorectal Cancer ◽  
Small Bowel ◽  
Ileorectal Anastomosis ◽  
Total Colectomy ◽  
Postoperative Bleeding ◽  
Laparoscopic Approach ◽  
Paediatric Surgery ◽  
Open Approach ◽  
Defecatory Function ◽  
Significant Difference

Introduction Total colectomy and ileorectal anastomosis can result in significant defecatory frequency and poor bowel function. The aim of this study was to assess whether a laparoscopic approach is associated with any improvement in this regard. Methods A single institution retrospective review was undertaken of patients undergoing elective total colectomy and ileorectal anastomosis between 2000 and 2011. Those undergoing emergency surgery and paediatric surgery were excluded. The primary outcome measure was satisfactory defecatory function after surgery. Results Forty-nine patients (24 male, 25 female) were included in the study. The median age was 48 years (range: 20–83 years). Laparoscopic total colectomy (LTC) was performed in 20 patients and open total colectomy (OTC) in 29 patients. Indications for surgery were slow colonic transit (n=17), colorectal cancer (CRC) (n=17), CRC with hereditary colorectal cancer syndrome (n=8), inflammatory bowel disease (n=4) and diverticular disease (n=3). In the LTC group, 85% had a satisfactory defecatory frequency of 1–6 motions per day compared with 45% in the OTC cohort (p=0.006). There was no statistically significant difference in bowel frequency related to primary pathology (benign vs cancer surgery, p=1.0). Postoperative complications for both groups included relaparotomy (n=3), anastomotic leak (n=2), small bowel obstruction (n=2), postoperative bleeding (n=1) and pneumonia (n=1). Conclusions This study indicates that long-term defecatory function is better following LTC than following OTC and ileorectal anastomosis. The mechanism for this improvement is unclear but it may relate to the underlying reason for surgery or possibly to reduced small bowel handling leading to fewer adhesions after laparoscopic surgery.

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