A Case of Intestinal Obstruction due to Internal Hernia due to a Mesenteric Defect after Laparoscopic Partial Colectomy

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

Sao Paulo Medical Journal ◽

10.1590/s1516-31802002000300006 ◽

2002 ◽

Vol 120 (3) ◽

pp. 84-86 ◽

Cited By ~ 15

Author(s):

Gustavo Gibin Duarte ◽

Belchor Fontes ◽

Renato Sérgio Poggetti ◽

Marcos Roberto Loreto ◽

Paulo Motta ◽

...

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Clinical Manifestations ◽

Acute Intestinal Obstruction ◽

Main Task ◽

Intestinal Necrosis ◽

Lesser Omentum ◽

Lesser Sac ◽

Internal Hernias

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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Serious postoperative complications induced by medical glue: three case reports

BMC Gastroenterology ◽

10.1186/s12876-019-1142-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Wei Li ◽

Mingming Xiao ◽

Yujia Chen ◽

Jiaxing Yang ◽

Donghui Sun ◽

...

Keyword(s):

Postoperative Complications ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Foreign Bodies ◽

Case Reports ◽

Duodenal Perforation ◽

Widespread Application ◽

Dense Adhesion ◽

Intestinal Anastomoses ◽

Surgical Closure

Abstract Background Various types of medical glues/adhesives/topical coagulants’ (referred to as MG hereinafter) have widespread application as surgical adhesives, and have been shown to be safe and effective for a broad range of usage, such as in hemostasis, reinforcement of intestinal anastomoses or sites of potential fluid leakage, adhesion of two surfaces, wound closure, and vascular embolization. However, inappropriate application of MG may sometimes lead to serious complications. Herein, we describe three cases of serious postoperative complications induced by a possible inappropriate use of N-butyl-2-cyanoacrylate MG (NBCA MG). Case presentation Three patients presented with abdominal pain (chronic pain in cases 1 and 2, and acute pain in Case 3), hematochezia (Case 2), and intestinal obstruction (Case 3). All patients had a history of abdominal surgery and intraoperative use of NBCA MG. Abdominal computed tomography and gastroenterological endoscopy revealed foreign bodies (solidified MG in cases 1 and 2) and intestinal obstruction related to a mass of residual non-absorbed MG causing an internal hernia from a dense adhesion (Case 3). All patients underwent exploratory laparotomy, which revealed duodenal perforation, colonic erosion, and an internal hernia, all of which was related to MG use. We undertook removal of the foreign bodies (cases 1 and 2), surgical closure of the site of duodenal erosion (Case 1), partial colectomy (Case 2), and partial enterectomy (Case 3). Conclusion Inappropriate application of MG may induce serious complications. We emphasize the importance of careful evaluation of the indications, dosage, and spraying thickness of MG in clinical practice. Serious complications caused by inappropriate application of MG should be reported to raise awareness in the surgical fraternity.

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Chylous Ascites Accompanying Internal Hernia after Total Gastrectomy with Roux-en-Y Reconstruction

Case Reports in Gastroenterology ◽

10.1159/000504565 ◽

2019 ◽

Vol 13 (3) ◽

pp. 481-486

Author(s):

Ryota Koyama ◽

Yoshiaki Maeda ◽

Nozomi Minagawa ◽

Toshiki Shinohara ◽

Tomonori Hamada

Keyword(s):

Internal Hernia ◽

Esophagogastric Junction ◽

Intestinal Resection ◽

Chylous Ascites ◽

Defect Closure ◽

Mesenteric Defect ◽

Esophagogastric Junction Cancer ◽

History Of ◽

Reliable Sign

We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett’s esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Thus, laparoscopic exploration was performed. Intraoperatively, accumulation of chylous ascites accompanying the internal hernia through the jejunojejunostomy mesenteric defect was observed, which was successfully treated with laparoscopic hernia reduction and defect closure by sutures without intestinal resection. Here, we discuss the case and report that along with previous studies, our study suggests that chylous ascites might be a reliable sign of intestinal viability for herniated intestines.

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Internal Hernia: Postoperative Complication of Roux-en-Y Gastric Bypass Surgery

The American Surgeon ◽

10.1177/000313480607200703 ◽

2006 ◽

Vol 72 (7) ◽

pp. 581-585 ◽

Cited By ~ 9

Author(s):

Aaron Eckhauser ◽

Alfonso Torquati ◽

Yassar Youssef ◽

Joan L. Kaiser ◽

William O. Richards

Keyword(s):

Gastric Bypass ◽

Length Of Stay ◽

Intestinal Obstruction ◽

Internal Hernia ◽

The United States ◽

Morbidity And Mortality ◽

Transverse Mesocolon ◽

Surgical Morbidity ◽

Internal Hernias ◽

Clinical Awareness

Obesity surgery is becoming one of the most common general surgery procedures done in the United States. Internal hernias are a known and increasingly more common occurrence after laparoscopic roux-en-Y gastric bypass (LRYGB). Increased clinical awareness of this complication will lead to decreased surgical morbidity and mortality. We retrospectively reviewed our database of 529 patients who had undergone LRYGB from 2000 to 2005 and identified those presenting with intestinal obstruction from an internal hernia. The type of internal hernia (jejunojejunostomy, transverse mesocolon, roux limb mesentery [Peterson's hernia]), length of time from presentation to operative intervention, and length of stay were obtained for all patients. Of 529 laparoscopic retrocolic retrogastric LRYGBs, 13 internal hernias (2.5%) were identified in 13 different patients. Eight of the hernias were at the mesenteric defect created by the jejunojejunostomy (62%), 3 originated from the transverse mesocolon defect (23%), and 2 were a Peterson's hernia (15%). The median time from initial operation to repair was 150 days. The average time from presentation to operative repair was 29.2 hours (range, 5–67.5 hours). The median length of stay was 3 days (range, 1.5–45 days). Eleven hernias were repaired laparoscopically (85%). There were no mortalities associated with obstruction from the internal hernia. Intestinal obstruction from an internal hernia after LRYGB is becoming increasingly more common. General awareness of this condition and high clinical suspicion allow for prompt surgical intervention with decreased morbidity and mortality.

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