Internal hernia through dual defects: defects in transverse mesocolon and lesser omentum a rare presentation: case report

Internal hernias have the potential to cause small bowel obstruction. Congenital internal hernias are impossible to diagnose clinically and radiologically in asymptomatic patients. We presented a case of 36 years male with complaints of pain abdomen abdominal distension and vomiting, contrast-enhanced CT showed an internal hernia with small bowel obstruction. On exploration, small bowel loops were identified near the lesser curvature and they are congested an edema was present, a defect of 5×1 cm was identified in the transverse mesocolon and was managed by reducing the hernia sac and closure of the defect in the mesentery of the transverse colon. If the intervention was delayed internal hernia might lead to ischemia, gangrene increasing morbidity and mortality. Early intervention is the key to decrease morbidity and mortality.

Case Report: Right paraduodenal hernia – a unique case of rare internal hernia presenting as acute small bowel obstruction

Paraduodenal hernia, a rare internal hernia, is an uncommon cause of small bowel obstruction. We present a case report of a 45-year-old male presenting to the emergency department with complaints suggestive of small bowel obstruction. Abdominal plain X-ray was also suggestive of small bowel obstruction. Emergency laparotomy showed intraoperative findings of right sided paraduodenal hernia with dilated small bowel. Postoperative hospital stay was uneventful and the patient was doing well during 24 months of follow up with no active complaints. Paraduodenal hernia should be considered as part of the differential diagnosis of small bowel obstruction in patients who have repeated attacks and no prior history of abdominal surgery. Surgeons need to have an astute clinical acumen in diagnosing internal hernias to avoid repercussions and fatal events.

A Case Report of a Cecal Bascule with Internal Herniation through the Foramen of Winslow

Internal hernias are a rare phenomenon, and even rarer is a herniation through the foramen of Winslow. We report a rare case of an 81 year old female presenting with vague abdominal symptoms who was found to have a cecal bascule herniating through the foramen of Winslow treated with surgery.

Incidence of Symptomatic Internal Hernia following Minimal Invasive colorectal surgery: A Single Center Experience

Laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant diseases. Recent reviews suggest that the incidence of symptomatic internal hernias after laparoscopic colorectal resection is from 0.39 to 0.65%. Unlike in open surgery, laparoscopic closure of a mesenteric defect is inherently challenging as inadvertent injury to the marginal vessels may compromise blood supply to the anastomosis. For these reasons, many surgeons leave the defect open during laparoscopic surgery. But this may lead to development of post-operative internal hernia through the defect. This is a retrospective study where we included 149 patients who underwent laparoscopic/ robotic colorectal surgeries from March 2019 to March 2020. Data pertaining for following variables were collected which included age, sex, indication for surgery, location of the pathology, splenic flexure mobilization. The incidence of internal hernia among these patients were calculated and assessed using SPSS 20. Incidence of internal hernia was found to be 0.67% which was diagnosed and treated on the 18th post-operative day of initial surgery. Internal hernia is a rare but important complication of laparoscopic/robotic colorectal surgery with a high mortality rate if not diagnosed early. Defect closure is still controversial during the initial surgery and probably not indicated for all patients and depends on surgeon’s preference.

Congenital Internal Hernia: Rare Cause of Acute Abdominal Pain

Acute abdominal pain is a common presenting symptom that possesses a wide differential. Congenital internal hernias are a rare condition that often presents with abdominal pain and can lead to obstruction. Early diagnosis is often difficult and therefore can present acutely and in an emergent setting. Prompt recognition of symptoms and evaluation are important to prevent poor prognosis. We are presenting a case of a congenital internal hernia in a patient presenting with nonspecific symptoms. Prompt diagnosis and subsequent surgical intervention allowed for appropriate management and resolution of symptoms.

Left Paraduodenal Hernia Presenting as Closed Loop Jejunal Obstruction in a Young Female: An Enigmatic and Perilous Differential of Acute Abdomen

Internal hernia is a rare cause of intestinal obstruction, accounting for <2% of cases with paraduodenal type being the most common. An internal hernia, mostly acquired, develops due to protuberance of the intestine through a gap in the peritoneum or mesentery formed as a result of an antecedent abdominal operation such as gastric bypass or liver transplant, ischemic injury, peritonitis, or trauma. Paraduodenal hernias (PDHs) are congenital anomalies, secondary to a failed fusion of mesentery with parietal peritoneum along with rotational midgut errors, causing the evolution of potential space for herniation within the left paraduodenal fossa. Primary internal hernias can have a varied clinical presentation and cause significant mortality and morbidity if left untreated. We report the case of a 20-year-old female with chronic pain in abdomen and intestinal obstruction due to left PDH (LPDH). The prompt diagnosis led to timely exploration and reduction of entrapped jejunum, with prudent closure of the hiatus, while circumventing any injury to the adjacent mesenteric circulation. No postoperative ileus arose, and recovery was uneventful.

A mesenteric defect causing internal herniation and ischaemia of both the ascending and sigmoid colons, treated with a bowel preserving surgery

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.

Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass?

Purpose Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB. Methods Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, with 493 patients without jejunal mesenteric defect closure and 292 patients with closure by non-absorbable suture, and a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored. Results Through primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5 to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery reduced the rate of IH from 5.3 to 2.4%. Higher weight loss seemed to increase the risk of developing an IH. Conclusion The closure of the jejunal mesenteric defect by non-absorbable suture may reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, particularly in patients with good weight loss. The Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.