Laparoscopy-Assisted Repair for Intersigmoid Hernia

Intersigmoid hernia is a rare clinical entity. Only 6 cases of laparoscopic repair for intersigmoid hernia have been reported since 1977. We herein report such a case, which was successfully diagnosed preoperatively and treated with laparoscopic repair. A 50-year-old man with a chief complaint of abdominal pain and vomiting was admitted for the treatment of small bowel obstruction. The patient had no history of abdominal surgery. Computed tomography showed a dilated small bowel and a closed loop of small bowel dorsal to the sigmoid colon and the sigmoid mesocolon. With a diagnosis of an incarcerated internal hernia, the patient underwent emergency laparoscopy-assisted surgery. Laparoscopy showed that the ileum had herniated into the intersigmoid fossa, and therefore the patient was diagnosed with an intersigmoid hernia. Because bowel ischemia was not observed, we reduced the incarcerated small bowel, and the hernial defect was widely opened. After operation, the patient developed ileus and was treated with transnasal ileus tube. Thereafter, the patient made a satisfactory recovery and was discharged on postoperative day 21. The patient is in good general condition without ileus 42 months postoperatively.

Download Full-text

Predictors of Ischemic Bowel in Patients with Small Bowel Obstruction

The American Surgeon ◽

10.1177/000313481608201030 ◽

2016 ◽

Vol 82 (10) ◽

pp. 992-994 ◽

Cited By ~ 6

Author(s):

Michael P. O'Leary ◽

Angela L. Neville ◽

Jessica A. Keeley ◽

Dennis Y. Kim ◽

Christian De Virgilio ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bowel Ischemia ◽

Wall Thickening ◽

Ischemic Bowel ◽

Operative Exploration ◽

Common Etiology ◽

History Of ◽

Exploratory Laparoscopy

Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination. Multivariate logistic regression was used to determine factors independently associated with bowel ischemia or ischemic perforation. One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis ( P = 0.304) and acidosis ( P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO ( P = 0.618), tachycardia ( P = 0.111), fever ( P = 0.859), and time from admission to operation ( P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (≤134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. Awareness of these predictors should heighten the concern for ischemic bowel in patients presenting with SBO.

Download Full-text

Small Bowel Ischemia after Roux-en-Y Gastric Bypass Complicated by Pregnancy: A Case Report

The American Surgeon ◽

10.1177/000313480507100312 ◽

2005 ◽

Vol 71 (3) ◽

pp. 231-234 ◽

Cited By ~ 8

Author(s):

Anthony Charles ◽

Shirley Domingo ◽

Aaron Goldfadden ◽

Jason Fader ◽

Richard Lampmann ◽

...

Keyword(s):

Morbid Obesity ◽

Gastric Bypass ◽

Case Report ◽

Small Bowel ◽

Bowel Ischemia ◽

Unusual Complication ◽

Childbearing Age ◽

Diffuse Abdominal Pain ◽

Gastric Bypass Procedure ◽

History Of

Small bowel obstruction is an unusual complication of pregnancy. Its occurrence after Roux- en-Y gastric bypass (RYGB) for morbid obesity complicated by pregnancy is rare. Morbid obesity describes body weight at least 100 lb over the ideal weight, or a body mass index (BMI) ≥40. Surgery offers the only viable treatment option with long-term weight loss and maintenance. This case report involves a 23-year-old female at 25 weeks gestation with a 1-day history of diffuse abdominal pain and vomiting. She had a RYGB with a 15 cc micropouch 6 months prior to the commencement of this pregnancy. All radiologic investigations were normal. Esophagogastroscopy was performed revealing an ischemic Roux limb of the gastric bypass. At laparotomy, an internal hernia involving the afferent limb was identified at the site of the Roux anastomosis compromising portions of both the afferent and Roux limbs. Nonviable portions of both the afferent and Roux limbs were resected. Gastrointestinal continuity was achieved by fashioning a gastro-gastrostomy and a jejuno-jejunostomy, thus reversing the original gastric bypass procedure. The immediate postoperative period was complicated by fetal demise. With the increase in bariatric surgery, small bowel ischemia after Roux- en-Y gastric bypass will most likely become more prevalent, particularly in women of childbearing age.

Download Full-text

Complexities of an uncomplicated symptom: two cases of umbilical discharge

BMJ Case Reports ◽

10.1136/bcr-2020-235604 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235604

Author(s):

Nitin Agarwal ◽

Nikhil Gupta ◽

Manu Vats ◽

Mradul Garg

Keyword(s):

Small Bowel ◽

Closed Loop ◽

Exploratory Laparotomy ◽

Abdominal Tuberculosis ◽

Mesenteric Lymph Nodes ◽

Mesenteric Lymph ◽

Antituberculosis Therapy ◽

Complex Fistula ◽

History Of ◽

Resection And Anastomosis

A 10-year-old boy presented with a low volume feculent umbilical discharge associated with fever and anorexia. Exploratory laparotomy revealed a complex fistula communicating with multiple small bowel loops and extensive peritoneal nodules with caseous mesenteric lymph nodes; suggestive of abdominal tuberculosis. Fistulectomy, adhesiolysis and a diversion jejunostomy were done and antituberculosis therapy was started. A 20-year-old man presented with serous umbilical discharge, having a history of similar complaints in his infancy. While he was being investigated, he developed peritonitis and had to be operated on emergency basis. An umbilical sinus connected with a fibrous band to Meckel diverticulum and a proximal closed loop small bowel obstruction perforation were found. Resection and anastomosis of the affected segment were done, and the patient recovered well.

Download Full-text

Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction

Abdominal Imaging ◽

10.1007/s00261-014-0335-2 ◽

2014 ◽

Vol 40 (5) ◽

pp. 1097-1103 ◽

Cited By ~ 16

Author(s):

Kazuaki Nakashima ◽

Hideki Ishimaru ◽

Toshifumi Fujimoto ◽

Takashi Mizowaki ◽

Kazunori Mitarai ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Diagnostic Performance ◽

Closed Loop ◽

Bowel Ischemia ◽

Ct Findings

Download Full-text

Closed Loop Obstruction from Epiploic Appendage Adhesion Mimicking Pericecal Internal Hernia

Case Reports in Radiology ◽

10.1155/2018/4767516 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Fatima Sharif ◽

Paul Samuel Sander ◽

Ali Sharif ◽

Grace Montenegro ◽

Robert Garrett

Keyword(s):

Bowel Obstruction ◽

Internal Hernia ◽

Closed Loop ◽

Ascending Colon ◽

Internal Hernias ◽

History Of ◽

Epiploic Appendage ◽

High Index Of Suspicion ◽

Sigmoid Mesocolon ◽

Abdominal Compartment

Internal hernias involve herniation of viscera into an abdominal compartment through a defect in the mesentery or peritoneum. Herniation may occur through normal anatomic structures or through pathologic defects secondary to congenital abnormality, inflammation, trauma, or surgery. Patients with an internal hernia most commonly present with acute bowel obstruction. While internal hernia is an uncommon cause of bowel obstruction, making up approximately 0.2-0.9% of cases (Choi, 2017), the incidence is increasing due to greater use of techniques such as Roux-en-Y for liver transplant and gastric bypass. There are multiple types of internal hernia, including paraduodenal, Foramen of Winslow, sigmoid mesocolon, pericecal, transmesenteric, transomental, supravesical, and pelvic. We present a case in which a transverse colon epiploic appendage adhesion to the ascending colon mesentery resulted in a closed loop obstruction mimicking a pericecal internal hernia. Radiologists should be aware of the imaging findings of closed loop obstruction related to internal hernia and maintain a high index of suspicion in patients with history of prior abdominal surgery presenting with bowel obstruction. It is useful for radiologists to understand that adhesions may result in internal hernias, which mimic the classically described categories.

Download Full-text

Single-Incision Laparoscopic Surgery for Intersigmoid Hernia

Case Reports in Surgery ◽

10.1155/2014/589649 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Takahiro Watanabe ◽

Hidetoshi Wada ◽

Masanori Sato ◽

Yuichirou Miyaki ◽

Norihiko Shiiya

Keyword(s):

Laparoscopic Surgery ◽

Small Bowel ◽

Internal Hernia ◽

Closed Loop ◽

Single Incision ◽

Previous History ◽

Uneventful Recovery ◽

Single Incision Laparoscopic Surgery ◽

Current Case ◽

History Of

Intersigmoid hernia is a rare form of internal hernia. Here, we report a case of intersigmoid hernia and provide a brief review of the 62 cases involving the mesosigmoid reported in Japan from 2000 to 2013. In the current case, a 26-year-old man with no previous history of abdominal surgery presented with abdominal pain and vomiting. Abdominal computed tomography revealed an extensively dilated small bowel and a closed loop of small bowel in the mesosigmoid. The patient was diagnosed with an intestinal obstruction due to an incarcerated internal hernia involving the mesosigmoid. There was no blood flow obstruction at the incarcerated bowel. An elective single-incision laparoscopic surgery was performed after decompression of the bowel using ileus tube. As the ileum herniated into the intersigmoid fossa, the patient was diagnosed with an intersigmoid hernia. The incarcerated small bowel was reduced in order to make it viable, and the hernial defect was closed with interrupted sutures. The patient had an uneventful recovery and was discharged on postoperative day five.

Download Full-text

Small Bowel Ischemia due to Jejunum Volvulus in Pregnancy: A Case Report

Case Reports in Obstetrics and Gynecology ◽

10.1155/2012/485863 ◽

2012 ◽

Vol 2012 ◽

pp. 1-2 ◽

Cited By ~ 3

Author(s):

Ioannis Vassiliou ◽

Aliki Tympa ◽

Michalis Derpapas ◽

Georgios Kottis ◽

Nikolaos Vlahos

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Small Bowel ◽

Mortality Rate ◽

Intestinal Obstruction ◽

Open Repair ◽

Bowel Ischemia ◽

Midgut Volvulus ◽

History Of ◽

In Pregnancy

The diagnosis of intestinal obstruction in pregnancy is difficult, as the symptoms may mimic pregnancy-associated complaints. The surgical management is challenging, as the mortality rate of midgut volvulus in pregnancy is high. We report the case of a 35-year-old woman at 21 weeks and 5 days of gestation with small bowel obstruction who presented to our institution with a 24 h history of colicky abdominal pain and nausea and who finally had a successful open repair.

Download Full-text

Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

BMJ Case Reports ◽

10.1136/bcr-2020-236429 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236429

Author(s):

Bankole Oyewole ◽

Anu Sandhya ◽

Ian Maheswaran ◽

Timothy Campbell-Smith

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Magnetic Beads ◽

Iliac Fossa ◽

Serous Fluid ◽

Magnetic Resonance Scan ◽

History Of ◽

Right Iliac Fossa Pain ◽

Multiple Episodes ◽

Safety Netting

A 13-year-old girl presented with a 3-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 presented again 6 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. Intraoperative findings revealed 200 mL 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 magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

Download Full-text

Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

Scandinavian Journal of Surgery ◽

10.1177/1457496920982763 ◽

2021 ◽

pp. 145749692098276

Author(s):

M. Podda ◽

M. Khan ◽

S. Di Saverio

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Conservative Management ◽

Bowel Ischemia ◽

Current Evidence ◽

First Episode ◽

Adhesive Small Bowel Obstruction ◽

Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

Download Full-text

Internal herniation during pregnancy after banded Roux-en-Y gastric bypass: a unique location

BMJ Case Reports ◽

10.1136/bcr-2020-236798 ◽

2020 ◽

Vol 13 (12) ◽

pp. e236798

Author(s):

Daniëlle Susan Bonouvrie ◽

Evert-Jan Boerma ◽

Francois M H van Dielen ◽

Wouter K G Leclercq

Keyword(s):

Gastric Bypass ◽

Small Bowel ◽

Neonatal Intensive Care ◽

Postoperative Recovery ◽

Internal Herniation ◽

Referral Centre ◽

Mri Scan ◽

Tertiary Referral Centre ◽

Bariatric Complications ◽

History Of

A 26-year-old multigravida, 30+3 weeks pregnant woman, was referred to our tertiary referral centre with acute abdominal pain and vomiting suspected for internal herniation. She had a history of a primary banded Roux-en-Y gastric bypass (B-RYGB). The MRI scan showed a clustered small bowel package with possible mesenteric swirl diagnosed as internal herniation. A diagnostic laparoscopy was converted to laparotomy showing an internal herniation of the alimentary limb through the silicone ring. The internal herniation was reduced by cutting the silicone ring. Postoperative recovery, remaining pregnancy and labour were uneventful. During pregnancy after B-RYGB, small bowel obstruction can in rare cases occur due to internal herniation through the silicone ring. Education regarding this complication should be provided before bariatric surgery. Treatment of women, 24 to 32 weeks pregnant, in a specialised centre for bariatric complications with a neonatal intensive care unit is advised to improve maternal and neonatal outcome.

Download Full-text