An unusual case of intestinal obstruction due to internal herniation from adhesions between two appendices epiploicae

BACKGROUND: Internal hernias are uncommon causes of acute abdomen and intestinal obstruction. Internal herniation due to appendices epiploicae is very rare with only six cases reported in the literature.CASE REPORT: We, herein, present the report of a 64-year-old female who presented with features of intestinal obstruction due to internal herniation of a loop of small intestine through an orifice formed by the fusion of two appendices epiploicae. The band was divided into release the entrapped loop of bowel.CONCLUSION: A high index of suspicion with prompt surgical intervention will improve outcome.

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An unusual case of small bowel obstruction secondary to internal herniation of distal ileum through a rent between adhered inflamed vermiform appendix and appendices epiploicae

International Surgery Journal ◽

10.18203/2349-2902.isj20214779 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3741

Author(s):

Rudraiah H. G. M. ◽

Benita Davis

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Vermiform Appendix ◽

Distal Ileum ◽

Successful Outcome ◽

Internal Herniation ◽

Abdominal Tumor ◽

Surgical Exploration ◽

Appendices Epiploicae ◽

High Index Of Suspicion

Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.

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AN UNUSUAL CASE OF INTESTINAL, OBSTRUCTION

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1926.tb40470.x ◽

1926 ◽

Vol 2 (17) ◽

pp. 557-558 ◽

Cited By ~ 1

Author(s):

W. R. Griffiths

Keyword(s):

Intestinal Obstruction ◽

Unusual Case

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Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02629-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

P. K. B. S. C. Bandara ◽

A. M. Viraj Rohana ◽

Aloka Pathirana

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Intestinal Obstruction ◽

Reflux Disease ◽

Bowel Loop ◽

Internal Herniation ◽

Small Bowel Loop ◽

Foramen Of Winslow

Abstract Background Intestinal obstruction due to internal herniation of the bowel is a rare clinical entity which is often overlooked in the differential diagnosis of patients with abdominal pain who have no previous history of abdominal surgery. Several sites of bowel internal herniation have been described, amongst which internal herniation through the foramen of Winslow accounts for about 8% of cases. These patients present with nonspecific abdominal pain associated with symptoms of gastroesophageal reflux disease, and hence the diagnosis is often overlooked. The usual symptoms of intestinal obstruction can be delayed, which results in a delay in diagnosis and gangrene of the herniated bowel segment. Abdominal radiographs and computed tomography are helpful in the diagnosis. Open reduction is the management of choice; however, laparoscopic reduction has also been attempted, with good results. Case presentation We report a case of a middle-aged Sri Lankan man who presented with features of gastroesophageal reflux disease, developed features of intestinal obstruction and was found to have a gangrenous small bowel loop which had herniated through the foramen of Winslow. Following needle aspiration and reduction of the herniated small bowel loop, the gangrenous part of the small bowel was resected and an ileoileal anastomosis performed. The large foramen of Winslow was partially closed with interrupted stitches. The patient made an uneventful recovery. Conclusion Since delayed diagnosis of bowel obstruction is detrimental, it is of utmost importance to diagnose it early. Because internal herniation of the small bowel through the foramen of Winslow presents with nonspecific symptoms including features of gastroesophageal reflux disease, as documented in several cases worldwide and also presented by our patient, there should be a high degree of suspicion of internal herniation of the bowel causing bowel obstruction and low threshold for extensive investigation of patients presenting with symptoms of gastroesophageal reflux disease which does not resolve with usual medication.

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Intestinal obstruction caused by pericecal internal herniation

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa003 ◽

2020 ◽

Vol 2020 (2) ◽

Author(s):

Floris B Poelmann ◽

Ewoud H Jutte ◽

Jean Pierre E N Pierie

Keyword(s):

Abdominal Pain ◽

Intestinal Obstruction ◽

Acute Abdominal Pain ◽

Treatment Preference ◽

Treatment Modalities ◽

Internal Herniation ◽

Lower Quadrant ◽

Surgical History ◽

The Right ◽

Right Lower Quadrant

Abstract Intestinal obstruction caused by pericecal internal herniation are rare and only described in a few cases. This case describes an 80-year-old man presented with acute abdominal pain, nausea and vomiting, with no prior surgical history. Computed tomography was performed and showed a closed loop short bowel obstruction in the right lower quadrant and ascites. Laparoscopy revealed pericecal internal hernia. This is a viscous protrusion through a defect in the peritoneal cavity. Current operative treatment modalities include minimally invasive surgery. Laparoscopic repair of internal herniation is possible and feasible in experienced hands. It must be included in the differential diagnoses of every patient who presents with abdominal pain. When diagnosed act quick and thorough and expeditiously. Treatment preference should be a laparoscopic procedure.

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Congenital sigmoid mesocolic defect as a cause of neonatal intestinal obstruction

BMJ Case Reports ◽

10.1136/bcr-2019-230253 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230253

Author(s):

Kanika Sharma ◽

Anjan Dhua ◽

Deena Thomas ◽

Mari Jeeva Sankar

Keyword(s):

Intestinal Obstruction ◽

Relevant Literature ◽

Clinical Signs ◽

Clinical Judgement ◽

Internal Herniation ◽

Neonatal Intestinal Obstruction ◽

Abdominal Exploration ◽

Neonatal Presentation

Internal herniation through congenital sigmoid mesocolic defect as a cause of neonatal intestinal obstruction is rarely reported. Clinical judgement combined with judicious use of investigations and prompt exploration is essential to provide immediate relief of the obstruction and salvage the herniated loop of bowel, which otherwise might lead to morbidity and even death. We present a neonate with internal herniation of the ileum through a congenital mesocolic defect which was diagnosed by a prompt abdominal exploration in view of persistent clinical signs of intestinal obstruction. The relevant literature is also discussed highlighting the rarity of neonatal presentation of sigmoid mesocolic defect.

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Transverse colon volvulus in a patient with sickle cell disease

BMJ Case Reports ◽

10.1136/bcr-2018-228863 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228863 ◽

Cited By ~ 2

Author(s):

Hussain Adnan Abdulla ◽

Eman Hamza ◽

Ali Dhaif

Keyword(s):

Sickle Cell Disease ◽

Intestinal Obstruction ◽

Sickle Cell ◽

Transverse Colon ◽

Unusual Case ◽

Large Bowel Obstruction ◽

Cell Disease ◽

Postoperative Course ◽

Colon Volvulus ◽

High Index Of Suspicion

Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course.

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