Transmesosigmoid hernia: report of a case

Sigmoid mesocolon hernia is an uncommon type of internal hernia. A 63-year-old man who presented with pain in the left side of the abdomen and nausea was referred to our department for treatment of ileus. He was initially managed conservatively, but as his symptoms became progressively worse, a laparoscopy was done, which revealed hemorrhagic ascites and necrosis of the small intestine in the lower abdomen. An open laparotomy was subsequently performed and the intraoperative findings were consistent with a transmesosigmoid hernia. There was an abnormal defect in the sigmoid mesocolon and protrusion of about 30 cm of small bowel through this abnormal opening, which had resulted in strangulation of the bowel. The necrosed part of the intestine was resected and the defect was closed. Received: November 9, 2001 / Accepted: May 7, 2002 Reprint requests to: T. Sasaki     

Strangulated Umbilical Hernia in a Child: Report of a Case

Most umbilical hernias in children close spontaneously. Complications associated with umbilical hernias are rarely observed during follow-up. We report herein a 5-month-old girl with a strangulated umbilical hernia. Her umbilicus was hard, reddish, and irreducible. Plain radiography of the abdomen showed signs of mechanical ileus. The patient was thus diagnosed to have a strangulated umbilical hernia. A 5-cm section of the ascending colon and a 5-cm section of the terminal ileum, as well as the cecum and appendix, were congested, edematous, and erythematous, and together were enclosed by a firm hernial ring. A closure of the fascial defect and umbilicoplasty were performed. The postoperative course was uneventful. In patients with infantile umbilical hernias, strangulation may occur as the fascial defect decreases in size. Received: May 30, 2000 / Accepted: January 9, 2001     

Transmesosigmoid Hernia: Report of a Case and Review of the Literature

We report a case of a transmesosigmoid hernia in a 6 weeks postpartum woman. We found 14 previous reports of this rare type of internal hernia. Our patient presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiographic examination were not diagnostic. An early laparoscopy was performed and a herniation of a small intestine loop through a hole in the sigmoid mesocolon was seen. The hernia was reduced and the defect in the sigmoid mesocolon was closed laparoscopically. The small intestine was viable and enterectomy could be avoided. The role of laparoscopy and potential causes of this type of hernia are discussed.     

A Left Paraduodenal Hernia Causing Acute Bowel Obstruction: a Case Report

We present the case of a 54-year old woman who presented twice at our emergency department with progressive abdominal pain. Over the last few years, multiple short periods of abdominal pain had occurred: the pain always resolved spontaneously after a few hours. She had no past medical history. CT scan revealed a sac-like mass of small bowel loops to the left of the ligament of Treitz, consistent with the diagnosis of a left paraduodenal hernia. On laparotomy, a left paraduodenal hernia with incarceration of small bowel loops was found; the herniated loops were reduced and the hernia orifice closed. The anatomy, treatment and importance of considering this uncommon diagnosis when examining a patient with acute small bowel obstruction are discussed.     

Small Intestinal Strangulation Due to a Rare Type of Primary Internal Hernia

Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.     

Unusual Hernia in a Colostomy Closure Site

This is a case report of an interstitial hernia following previous transverse loop colostomy closure. There are no reported cases in the literature of gangrenous gall-bladder as the content of an interstitial hernia. This condition can present as a diagnostic challenge. We present a case with a previous reversal of a colostomy in the right upper quadrant presenting with a short history of a right iliac fossa mass and tenderness. Clinically, the patient was septic without any peritonitis. Subsequent computed tomography scan suggested the hernial sac contained gallbladder and loops of bowel. At surgery, a gangrenous gall-bladder was found within an interstitial incisional hernia (between the external and internal oblique muscle). Retrograde cholecystectomy was performed and bowel and hernia were reduced.The hernia was repaired in layers and patient had an uneventful recovery.     

Left Paraduodenal Hernia Causing Small Bowel Obstruction

A case of small bowel obstruction secondary to a left paraduodenal hernia is illustrated together with its radiological features and intra-operative appearance. Paraduodenal hernias are rare congenital causes of small bowel obstruction, and various approaches to surgical treatment are available including conventional open and minimally invasive laparoscopic techniques. This case presents one possible option for surgical management and briefly reviews the literature for the various surgical techniques and strategies available to the surgeon when faced with a left paraduodenal hernia.     

Predicting Strangulated Small Bowel Obstruction: An Old Problem Revisited

Background  Diagnosing intestinal strangulation complicating a small bowel obstruction (SBO) remains a considerable challenge. Despite decades of experience and numerous studies, no clinical indicators have been identified that reliably predict this life-threatening condition. Our goal was to determine which clinical indicators in patients with SBO can be used to independently predict the presence of strangulated intestine. Methods  Medical records were reviewed for 192 adult patients operated on for acute SBO over an 11-year period (1996–2006). Seventy-two preoperative clinical, laboratory, and radiologic findings at admission were examined. Data from patients with strangulated intestine were compared to data from patients without bowel compromise. Likelihood ratios were generated for each significant parameter in a multivariate logistic regression analysis. Results  Forty-four patients had bowel strangulation requiring bowel resection, and 148 had no strangulation. The most significant independent predictor of bowel strangulation was the computed tomography (CT) finding of reduced wall enhancement, with a sensitivity and specificity of 56% and 94% [likelihood ratio (LR) 9.3]. Elevated white blood cell (WBC) count and guarding were moderately predictive (LR 1.7 and 2.8). Conclusion  Regression analysis of multiple preoperative criteria demonstrates that reduced wall enhancement on CT, peritoneal signs, and elevated WBC are the only variables independently predictive of bowel strangulation in patients with SBO. PRESENTED AT: Pacific Coast Surgical Association (PCSA) February 16, 2008 San Diego, CA     

Strangulated paraumbilical hernia-An unusual complication of a Meckel's diverticulum

INTRODUCTIONMeckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Most are asymptomatic but can rarely present with varies forms of intestinal obstruction.PRESENTATION OF CASEWe present an unusual case of an elderly African woman with a massive strangulated paraumbilical hernia as a complication from a Meckel's diverticulum.DISCUSSIONMeckel's diverticulum presenting as a strangulated paraumbilical hernia is uncommon and can be difficult to diagnose. It is often only found intraoperatively. Delay in referral due to poor access can potentially lead to adverse outcome.CONCLUSIONAlthough uncommon, a through clinical assessment is of paramount importance and timely operative intervention must occur in order to provide the best outcome for these patients.     

Small Bowel Obstruction and Internal Hernias during Pregnancy after Gastric Bypass Surgery

Small bowel obstruction (SBO) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Internal hernia (IH) a potential problem associated with RYGB, can have severe consequences if not diagnosed. We present two cases of SBO due to IH during pregnancy after laparoscopic RYGB (LRYGB). Both patients underwent an antecolic, antegastric LRYGB. In both patients a Petersen’s type IH was found. We reviewed the cases reported in the literature of SBO during pregnancy after RYGB. IH should always be ruled out in pregnant patients with previous RYGB and abdominal pain. Prompt surgical intervention is mandatory for a good outcome.     

Acute Small Bowel Obstruction Secondary to Ileal Endometriosis: Report of a Case

We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this case and others in the literature highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definitive treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence.     

Small Bowel Obstruction Secondary to Bezoar Impaction: A Diagnostic Dilemma

Background Gastrointestinal bezoar (GIB) is uncommon and is reported to occur in 4% of all admissions for small-bowel obstruction (SBO). Because of a lack of diagnostic features, it is often associated with a delay in treatment, with increased morbidity. In this article, we report our experience with managing bezoar-induced SBO and the role of early computed tomography (CT) imaging in establishing the diagnosis. Methods We retrospectively reviewed all cases of bezoar-induced SBO treated in our unit between 1999 and 2005. Results There were 43 patients, of whom 2 had a recurrence, giving a total of 45 episodes. The frequency of bezoar in our patients presenting with SBO was 4.3%. All patients were of Asian origin: 41 Chinese, 1 Indian, and 1 Malay. Twenty-eight (65%) patients had previous abdominal surgery of which 26 were gastric surgery. Thirty-eight (88%) patients were edentulous. Forty-one (91%) underwent serial abdominal radiography, whereas only 4 patients (9%) had either CT imaging or contrast study alone. Only 11 (24%) cases had a correct diagnosis of bezoar impaction made preoperatively by CT imaging. The diagnostic accuracy of CT imaging in our series was 65%, with six cases of misdiagnosis. Overall, CT led to a change in management of 76% (13 in 17). The median time to surgery from admission was 2 (0–10) days. There were 2 cases of ischemic bowel that necessitated bowel resection. The median length of hospital stay was 11 (5–100) days. Ten patients (22%) had postoperative complications, and there was one death. Conclusion Bezoar-induced SBO is uncommon and remains a diagnostic and management challenge. It should be suspected in patients with an increased risk of formation of GIB, such as previous gastric surgery, poor dentition, and a suggestive history of increased fibre intake. We advocate that CT imaging be performed early in these at-risk patients and in patients presenting with SBO with or without a history of abdominal surgery in order to reduce unnecessary delays before appropriate surgical intervention.     

Congenital Intra-Mesosigmoid Hernia- A Case Report of a Rare Sigmoid Mesocolon Hernia

Internal hernia is the protrusion of the viscera through normal or abnormal peritoneal or mesenteric apertures within the confines of peritoneal cavities.     

Small intestinal strangulation due to a primary internal paracecal hernia

The discovery of a paracolic hernia is an unusual event, even for an experienced specialist in colorectal surgery. We report a case of a 59-year-old woman with no previous history of abdominal surgery, who presented to the Emergency Department complaining of episodic abdominal pain and distension accompanied by a palpable mass in the right lower quadrant. At laparotomy, a paracecal hernia with small bowel volvulation was found. The prime objective of this report is to draw the clinician's attention to the necessity of making a rapid diagnosis of internal hernias.     

Small Bowel Obstruction Secondary to Intragastric Erosion and Migration of A Gastric Band

We describe what we believe to be the first reported case of intragastric erosion and migration to the jejenum of a laparoscopically inserted gastric band, 3 months after the original bariatric surgery was performed. This had caused ulceration and necrosis of the small bowel as the tension in the port tubing had caused the bowel to become concertinaed over it and resulted in a cheese-wire effect through the jejunal convolutions. As bariatric surgery becomes more common, patients with complications of their procedure may present to the general surgeon as an emergency. We recommend early intervention in patients with gastric erosion.     

腹腔镜右半结肠切除术不关闭系膜裂孔与术后肠梗阻关系的研究

目的探讨腹腔镜右半结肠切除术中不关闭系膜裂孔对术后内疝和肠梗阻发生的影响。方法回顾性分析北京大学第三医院普外科1994年10月～2010年9月169例腹腔镜右半结肠切除术后肠梗阻及内疝的发生情况。结果 169例随访时间中位数29个月（2～192个月）,15例（8.9%）发生肠梗阻,12例保守治疗缓解,3例再次手术,其中1例为经系膜裂孔内疝导致肠坏死,发生于术后26 d,内疝发生率为0.6%（1/169）,2例为粘连导致肠梗阻。术后早期肠梗阻（术后30 d内）发生率为5.9%（10/169）。粘连占引起术后肠梗阻原因的73.3%（11/15）。结论腹腔镜右半结肠切除术中不关闭系膜裂孔肠梗阻以粘连型为主,内疝发生率不高。