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

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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Strangulated small-bowel internal hernia through a defect in the broad ligament of the uterus presenting as acute intestinal obstruction: A case report

Case Reports in Women s Health ◽

10.1016/j.crwh.2021.e00310 ◽

2021 ◽

pp. e00310

Author(s):

Sardar Hassan Arif ◽

Ayad Ahmad Mohammed

Keyword(s):

Case Report ◽

Small Bowel ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Broad Ligament ◽

Acute Intestinal Obstruction

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Internal Hernia through Paraduodenal Recess with Acute Intestinal Obstruction: A Case Report

Indian Journal of Surgery ◽

10.1007/s12262-011-0243-4 ◽

2011 ◽

Vol 74 (4) ◽

pp. 354-355 ◽

Cited By ~ 7

Author(s):

Ayanat Husain ◽

Sanjay Bhat ◽

Akhilesh K. Roy ◽

Vijay Sharma ◽

Saurabh A. Dubey ◽

...

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Acute Intestinal Obstruction

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HERNIATION THROUGH LESSER SAC: A RARE TYPE OF PRIMARY INTERNAL HERNIA CAUSING SMALL INTESTINAL OBSTRUCTION

10.36106/ijsr/8418157 ◽

2020 ◽

pp. 1-2

Author(s):

Pritam Kar ◽

Ranjan George Baxla ◽

Abhishek Kushwaha ◽

Anup Kumar Mahato

Keyword(s):

Intestinal Obstruction ◽

Internal Hernia ◽

Abdominal Distension ◽

Jejunal Loop ◽

Bowel Loop ◽

Emergency Setting ◽

Imaging Features ◽

Rare Type ◽

Lesser Sac ◽

Internal Hernias

Primary internal hernia is a rare phenomenon, where there is protrusion of an abdominal organ mostly gut through epiploic foramen. Clinical presentation of internal hernia is non specific.Imaging has been of limited utility in cases of acute intestinal obstruction; moreover ,interpretation of imaging features is operator dependant. Thus internal hernias are usually detected at laparotomy and preoperative diagnosis in an emergency setting is either difficult or most of the time not suspected We describe the case of a 14-year-old male who presented with acute abdominal pain and abdominal distension with no history of trauma .A loop of jejunum was found to enter the lesser sac with multiple peforated jejunal loop 35cm distal to dj junction. .The segment of perforated bowel loop of length 10cm was resected and jejuno-jejunostomy was done.This is a rare type internal hernia into lesser sac.

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Internal Incarceration of Left Paraduodenal Hernia with Necrosis of Proximal Jejunum and Atypical Reconstruction of the Passage: A Case Report

Journal of Biomedical and Clinical Research ◽

10.1515/jbcr-2015-0116 ◽

2013 ◽

Vol 6 (2) ◽

pp. 139-142

Author(s):

Pentcho T. Tonchev ◽

Sergei D. Iliev ◽

Ivailo M. Presolski

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Proximal Portion ◽

Paraduodenal Hernia ◽

Proximal Jejunum ◽

Radiological Findings ◽

Transverse Mesocolon ◽

Internal Hernias ◽

Purulent Peritonitis

Summary Internal hernias are rare and most of them are diagnosed intraoperatively. We present a case of a 53-year-old man with proximal intestinal obstruction, caused by incarcerated internal hernia. During the operation, a proximal portion of 40 cm of the jejunum was found herniated and strangulated in the lesser sac through an opening of the transverse mesocolon. The jejunum was necrotic and local purulent peritonitis was present. After resection of the proximal 40 cm of the jejunum, the passage was restored using an unconventional approach. The distal duodenum was closed and, to protect the stump, the duodenum was ligated between its second and third parts. A latero-lateral anastomosis was made between the first part of duodenum and the jejunum. Anatomical, clinical and radiological findings, diagnosis and treatment of paraduodenal hernias are discussed in brief.

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Rare case of paracaecal hernia with intussusception presenting as small bowel obstruction: case report

International Surgery Journal ◽

10.18203/2349-2902.isj20201890 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1662

Author(s):

M. S. Kalyan Kumar ◽

Shyamsundar R. ◽

Sabari Girieasan M. ◽

R. Kannan ◽

S. Nedunchezhiyan

Keyword(s):

Intestinal Obstruction ◽

Internal Hernia ◽

Exploratory Laparotomy ◽

Acute Intestinal Obstruction ◽

Emergency Laparotomy ◽

High Morbidity ◽

Rare Presentation ◽

Ileal Loop ◽

Rare Type ◽

Internal Hernias

Primary internal hernias are very rare in adults. They are an unusual cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is highly nonspecific. Imaging has limited role in diagnosing the cause of acute intestinal obstruction. Internal hernias are usually detected at laparotomy. We report a case of a 61-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the caecum and ileo ileal intussusception was noted proximal to the herniated loop. The segment of intestine was resected and anastamosed then hernial defect was closed. Paracaecal hernias are the rare type of hernias in internal hernia. In our case, intussusception was noted proximal to the herniated ileal loop which is a very rare presentation. Intussusception was reported previously with paraduodenal type. One should always keep in mind while conducting emergency laparotomy, internal hernias can be a cause for intestinal obstruction.

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A Rare Type of Primary Internal Hernia Causing Small Intestinal Obstruction

Case Reports in Surgery ◽

10.1155/2016/3540794 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Sibabrata Kar ◽

Vandana Mohapatra ◽

Pratap Kumar Rath

Keyword(s):

Intestinal Obstruction ◽

Internal Hernia ◽

Acute Intestinal Obstruction ◽

High Morbidity ◽

Emergency Setting ◽

Imaging Features ◽

Rare Type ◽

Small Intestinal Obstruction ◽

Internal Hernias ◽

Small Intestinal

Primary internal hernias are extremely rare in adults. They are an important cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is nonspecific. Imaging has been of limited utility in cases of acute intestinal obstruction; moreover, interpretation of imaging features is operator dependant. Thus, internal hernias are usually detected at laparotomy and preoperative diagnosis in an emergency setting is either difficult or most of the time not suspected. We report herein a case of a 45-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the sigmoid colon in the left paracolic gutter. The segment of intestine was reduced and the hernial defect was closed. Our finding represents an extremely rare variant of retroperitoneal hernias.

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Internal hernia: Isolated small intestinal peritoneal encapsulation, a rare cause of acute intestinal obstruction in adolescent: A case report

Nigerian Journal of Medicine ◽

10.4103/1115-2613.278805 ◽

2018 ◽

Vol 27 (4) ◽

pp. 374

Author(s):

JA Abiahu ◽

TU Mbaeri

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Acute Intestinal Obstruction ◽

Peritoneal Encapsulation ◽

Small Intestinal

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Hernia interna estrangulada por plastrón en el tercio distal del apéndice cecal

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2019.62.6.03 ◽

2019 ◽

Vol 62 (6) ◽

pp. 24-27

Author(s):

Leslie M. Leyva Sotelo ◽

José E. Telich Tarriba ◽

Daniel Ángeles Gaspar ◽

Osvaldo I. Guevara Valmaña ◽

André Víctor Baldín ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Early Diagnosis ◽

Intestinal Obstruction ◽

Acute Abdomen ◽

Internal Hernia ◽

Wide Spectrum ◽

Internal Hernias ◽

Mild Abdominal Pain ◽

Made In

Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.

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