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.

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.

An interesting case of left paraduodenal hernia.

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.

scholarly journals The “Omega sign”: a new radiological sign for a rare type of internal hernia involving the sigmoid mesocolon

2020 ◽  
Vol 6 (2) ◽  
pp. 20190127
Author(s):  
Kino Ceon Francis ◽  
Candice Daley ◽  
Bonnie-Paul Regis Williams ◽  
Richard Bullock ◽  
Ulanda Singh ◽  
...  
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Sigmoid Colon ◽  
Preoperative Diagnosis ◽  
Radiological Sign ◽  
Radiological Findings ◽  
Rare Type ◽  
Internal Hernias ◽  
Sigmoid Mesocolon Hernia ◽  
Sigmoid Mesocolon

The transmesosigmoid hernia is a rare type of sigmoid mesocolon hernia. Its presentation is non-specific and thus hardly ever preoperatively diagnosed. Its diagnosis often requires surgical corroboration. This case report aims to improve on the preoperative diagnosis with a proposed observed sign on CT. All literature reviewed described radiological findings related to the small bowel; thus, features of small bowel obstruction was the “hallmark” of internal hernias. This paper intends to describe the features of the sigmoid mesocolon internal hernias, illustrate and propose a never reported configuration of the sigmoid colon. This sigmoid colon configuration has a resemblance to the omega sign. We intend to present a new hallmark sign, which may serve as a clue in the identification of internal hernias involving the sigmoid mesocolon.

scholarly journals Recurrent internal hernias after Roux-en-Y gastric bypass: An observational study in 1219 patients over 20 years

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
Y Fringeli ◽  
R Steffen ◽  
U Kessler ◽  
J Zehetner
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Laparoscopic Group ◽  
Small Bowel Resection ◽  
Median Percentage ◽  
Internal Hernias ◽  
Mesenteric Defects ◽  
Time Of Operation

Abstract Objective Internal hernia (IH) represents a well-known complication and the major cause of bowel obstruction after Roux-en-Y gastric bypass (RYGB) for morbid obesity. With the worldwide rise of performed RYGB, IH will become more frequent in the coming years. Lots of studies already addressed this issue to prevent its occurrence and improve its management. The aim of this study is to assess incidence and patterns of recurrence of IH. Methods A retrospective single-centre analysis was performed of prospectively collected follow-up data from patients who underwent a RYGB between January 2000 and December 2017 and who developed IH thereafter. Follow-up data were reviewed until December 2020. Both open (51) and laparoscopic procedures (1168) were included. All RYGB were performed using the antecolic technique with routine closure of the Petersen’s space (PS) and the mesenteric defect beneath the jejunojejunostomy (JJ). Only open mesenteric defects with incarcerated small bowel at the time of operation were considered as IH. Results One hundred thirty four patients presented with IH and all events occurred in the laparoscopic group (11.5%). Among the 134 patients with IH, a recurrence was observed in 35 patients (26.1%) after a median time of 13 months (range, 0-124) since the first IH. Seven patients presented more than 2 episodes of IH, among them one patient with 7 episodes. The median weight loss between the first and the second episode of IH was 0.0kg (range, -11.5-19.0) and the median percentage of excess weight loss achieved since the RYGB at the occurrence of the second IH was 97.2% (range, 55.3-111.2). Location of IH was PS in 70 patients (52.2%) at the time of the first IH and in 23 patients (65.7%) at the time of the second IH. Recurrence of IH at the same location was more frequent at the PS (22.9%) than at the JJ (10.9%). Overall, 185 operations for IH were performed, among them 132 (71.4%) laparoscopically. Only once, a small bowel resection was mandatory (0.5%). Conclusion For patients with laparoscopic RYGB, internal hernias represent a potential complication over a lifetime and have to be suspected even years after the index operation. One quarter of patients will develop a recurrence of IH and Petersen’s space is mostly involved.

scholarly journals Internal hernia - a rare cause of small bowel obstruction: a case report

2016 ◽  
Vol 4 (1) ◽  
pp. 427 ◽  
Author(s):  
Samir U. Rambhia ◽  
Premjeet Madhukar
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Internal Hernia ◽  
Previous History ◽  
Exploratory Laparotomy ◽  
Internal Hernias ◽  
Post Surgery ◽  
History Of ◽  
Acute Small Bowel Obstruction

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.

scholarly journals 78 A Lockdown Dilemma; Ingestion of Magnetic Beads Presenting as Right Iliac Fossa Pain and Sub-Acute Small Bowel Obstruction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Oyewole ◽  
A Sandhya ◽  
I Maheswaran ◽  
T Campbell-Smith
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Magnetic Beads ◽  
Iliac Fossa ◽  
Radiology Department ◽  
Magnetic Resonance Scan ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Acute Small Bowel Obstruction ◽  
Operative Findings

Abstract A 13-year-old girl presented with a three-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She represented six days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment as recommended by the radiology department. Intra-operative findings revealed 200mls of serous fluid in the pelvis, normal-looking appendix, dilated stomach, and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetized the laparoscopic instruments. A mini-laparotomy was performed with the extraction of fourteen magnetic beads and the repair of nine enterotomies. Foreign body ingestion is a known cause of abdominal pain, which in some cases might mimic or even be the cause of acute appendicitis. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

scholarly journals Caecal Herniation through the Foramen of Winslow: A Lesser Known Complication of the Lesser Sac

2019 ◽  
Vol 02 (02) ◽  
pp. 147-150
Author(s):  
Pia Charters ◽  
Andrew Lowe ◽  
Richard Keogan ◽  
Tom Edwards
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Surgical Intervention ◽  
Bowel Resection ◽  
Diagnostic Delay ◽  
High Morbidity ◽  
Foramen Of Winslow ◽  
Lesser Sac ◽  
Internal Hernias ◽  
Abdominal Hernias

AbstractThe foramen of Winslow is the omental communication between the greater and lesser sac. An internal hernia through the foramen of Winslow is extremely rare, accounting for <0.1% of abdominal hernias and 8% of internal hernias. The majority of lesser sac hernias contain small bowel only, less commonly cecum or omentum. Diagnostic delay is associated with high morbidity and mortality, and accurate radiological interpretation is invaluable to guide surgical intervention. As such, the recognition of foramen of Winslow herniation on computed tomography (CT) is paramount. We present a case of caecal herniation that was recognized early and reversed within 48 hours of presentation, without the need for bowel resection.

scholarly journals A rare case of intestinal obstruction caused by internal hernia through post hysterectomy peritoneal defect

2021 ◽  
Vol 8 (4) ◽  
pp. 1347
Author(s):  
Ravi Kumar Sabu Murugesan ◽  
Kannan Ross ◽  
Joyce Prabakar
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
Rare Case ◽  
Emergency Laparotomy ◽  
Female Status ◽  
Internal Hernias ◽  
Bowel Movements ◽  
Operative Findings ◽  
Increasing Trends

Internal hernia is a rare cause of intestinal obstruction. Nowadays acquired internal hernias are in increasing trends due to increased surgical procedures thus iatrogenic causes surpassing congenital internal hernias. Internal hernias after hysterectomy due to peritoneal defect is extremely rare. Here we present a case of 67 years old female status post hysterectomy ten years back, also a known type 2 diabetic presented to the emergency department with features suggestive of intestinal obstruction. Patient was taken up for emergency laparotomy and intra operative findings revealed small bowel loops herniating in a cavity that is formed by bladder anteriorly, caecum and sigmoid colon laterally and rectum posteriorly. Bowel loops were released. The bowel was found to be viable and the defect was closed. Bowel movements resumed on the third post-operative day. This case is presented here as it is an extremely rare case of internal hernia causing small bowel obstruction.

scholarly journals Right para duodenal hernia presenting as small bowel obstruction: a rare case report

2020 ◽  
Vol 7 (7) ◽  
pp. 2410
Author(s):  
Dipanshu Kakkar ◽  
Shubra Kochar ◽  
Sanjeev Prasad
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Abdominal Hernia ◽  
Midline Laparotomy ◽  
Internal Hernias ◽  
Hernia Formation ◽  
Rare Case Report ◽  
Operative Findings ◽  
The Right

Internal hernias are rare congenital anomalies. The most common internal hernias are para duodenal hernias (53%) followed by pericaecal hernias 13%. Para duodenal hernia, a rare congenital anomaly that arises from an error of rotation of the midgut, is the most common type of intra-abdominal hernia. There are two types, right and left para duodenal hernia, the right being less common.  Here we present a case of a 21 years old male presented in surgical emergency department non-passage of flatus and stools since, 5 days with associated nausea, vomiting and abdominal pain. Abdominal CT demonstrated signs of small bowel obstruction. A midline laparotomy was performed. Intra operative findings suggestive of right sided para duodenal hernia. Careful reduction of hernia and plication of sacs done with new D-J flexure formation. Para duodenal hernias are rare congenital entities. Left para duodenal hernia is more common than right. The right para duodenal hernia occurs when the pre arterial limb of the mid gut loop fails to rotate around the superior mesenteric artery. Symptoms may vary according to degree of obstruction or gut ischemia. Reduction of contents of the sac and plication of the sac to prevent further hernia formation and resection of small bowel in cases of gut gangrene remains the mainstay of the treatment.

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