A case of intestinal obstruction due to a hernia traversing the lesser sac

A case of a hernia traversing the lesser sac with a primary defect in the greater omentum and a secondary defect in the lesser omentum is reported herein. This type of internal hernia is extremely rare and we have found only three other reported cases apart from our case. All four cases in whom this type of hernia occurred were young people. The general manifestation resembles acute intestinal obstruction and a plain radiograph shows obstruction of the upper small intestine. An erect lateral view of the abdomen often shows the anatomical location more clearly. Bowel resection was performed in two cases and all of the four reported cases recovered uneventfully.     

Strangulated lesser sac hernia

Internal hernias account for less than 1% of acute mechanical bowel obstruction. Because of their rarety, they are often not considered in the clinical or radiologic diagnosis of bowel obstruction; diagnosis is often delayed, and is most often made at the time of surgery. We present images obtained during the management of a strangulated transomental internal hernia; computerized tomography permitted timely preoperative diagnosis and specifically adapted surgical therapy.     

Primary leiomyosarcoma of the lesser sac

A case of leiomyosarcoma arising in the lesser sac in a 64-year-old man is presented. A second operation was required because of local recurrence 6 years following the first operation. A review of the literature revealed that only eight cases of leiomyosarcoma arising in the lesser sac, including our case, were reported. Almost all of these patients had symptoms of abdominal pain or distension. The tumor tended to grow to a large size and about 90 percent were over 10 cm in the maximal diameter. The prognosis of these series was poor and our own patient seems to be the second 5 year survivor. Presented at the Kyushu Regional meeting of the Japan Surgical Society, Oita, July 2–3, 1983     

Lesser sac herniation through the greater omentum and gastro-pancreatic ligament: Report of a case

We report herein the case of a woman who developed a lesser sac hernia which was especially unusual in that the small bowel prolapsed through a defect in the greater omentum and was thereafter strangulated by a hole in the gastro-pancreatic ligament. The gastro-pancreatic ligament has never before been documented as causing an internal hernia. In our patient, a plain abdominal X-ray demonstrated as soft-tissue mass displacing the stomach to the left while abdominal computed tomography and ultrasonography showed a sac-like encapsulation of the small bowel loops between the liver and stomach. Careful evaluation of these radiographic findings allowed for the preoperative diagnosis of a lesser sac hernia to be made.     

Planned reduction of incarcerated groin hernias with hernia sac laparoscopy

Background: Laparoscopic techniques have been described as adjuncts in the management of acutely incarcerated groin hernias, with the intention of reducing operative morbidity and patients discomfort. However, the use of laparoscopy in acute incarcerations, as well as its appropriateness, remains to be elucidated. Herein we discuss the use of hernia sac laparoscopy in the algorithm of managing incarcerated groin hernias. Methods: Five patients presenting with small bowel obstruction secondary to incarcerated groin hernias underwent surgical reduction of the hernia followed by hernia sac laparoscopy. The purpose of hernia sac laparoscopy was to determine the viability of the incarcerated bowel segment based on color, peristalsis, and venous congestion. When bowel resection was required, a separate incision was made after repair of the hernia. Results: Bowel viability was assessed accurately with this method. Although hemorrhagic fluid in the hernia sac was noted in three patients, only one patient required a limited exploration through a separate incision for nonviable bowel. Postoperative recovery was standard, with no morbidity or mortality. Patients were discharged in 2–5 days. Conclusions: Hernia sac laparoscopy, without additional trocar placements, is a safe adjunct for determining the viability of the incarcerated bowel segment. This method reduces the need for laparotomy so long as the reduced incarcerated segment meets the criteria for viability. Videoscopic inspection potentially offers additional information, such as the existence of ascites and peritoneal tumors.     

Primary leiomyosarcoma arising in the lesser sac: Report of a case

We describe herein a very rare case of leiomyosarcoma arising in the lesser sac. A 58-year-old man with a psychiatric disorder was admitted to our department for the investigation of epigastralgia and nausea which he had been suffering since the previous month. A laparatomy revealed that the abdominal mass, found on physical examination, was a primary lesser omental tumor, histological examinations of which confirmed a diagnosis of leiomyosarcoma. The tumor cells showed a DNA diploid pattern. Leiomyosarcoma of the lesser sac is extremely unusual and it is important that it be distinguished from an extraluminal tumor of the abdomen.     

Internal hernia with triple hiatus of congenital origin: Report of a case

We report herein the case of a 65-year-old woman who was referred to our department with prolonged ileus symptoms despite conservative therapy. A plain abdominal radiograph showed intestinal gas shadows with an air-fluid level in the lesser curvature of the stomach. As no improvement was achieved by the insertion of a short tube, a long tube was inserted. A loop formation of the long tube in the subphrenic region was detected on an abdominal radiograph, and an enterogram showed an interruption in the ileum in the lower abdomen. The patient was diagnosed as having an adhesional ileus and a strangulated ileus due to a lesser sac hernia. A laparotomy was performed which revealed that the small intestine had herniated into the lesser sac space through a hiatus of Treitz' fossa and a hiatus in the transverse mesocolon. Furthermore, part of the small intestine had herniated through an omental hiatus. The herniated intestine was manually reduced and the hiatus was closed. However, as the right ovary was found to have adhered to the ileum and stenosis was seen, we were forced to perform partial resection of the ileum. Considering that this patient had no history of laparotomy in the upper abdomen, abdominal injury, or acute abdomen, it was surmised that the three abnormal hiatuses were congenital. Received: June 25, 1999 / Accepted: May 30, 2000     

Internal hernia. Report of nine cases

Summary Internal abdominal hernias are rare and develop when one or more viscera protrude through an intraperitoneal orifice while remaining within the peritoneal cavity. This orifice may be normal (Winslow's foramen) or paranormal (peritoneal fossae); these hernias possess a sac and are true hernias. Protrusion may be through a pathologic hole, without a sac, realizing an internal prolapse or procidentia. The clinical diagnosis is always difficult and leads to an urgent operation for intestinal obstruction. The treatment is often simple and the results are generally excellent.     

Internal Hernia as a Complication of Laparoscopic Roux-en-Y Gastric Bypass

Background Internal hernia (IH) is a well known complication of Roux-en-Y gastric bypass (RYGBP) which is more frequently encountered when the RYGBP is done laparoscopically. Methods Patients with IH were identified from a prospective data-base of morbidly obese patients undergoing bariatric surgery at our center. Results 10 patients with IH were identified out of 625 patients undergoing LRYGBP from 1998 to 2006 (incidence 1.6%). The defects were closed in the last 155 cases with non-absorbable running sutures. There were 8 women and 2 men with mean age 38 years (range 28–54).The mean interval of time elapsed between LRYGBP and clinical presentation of IH was 26.5 months (range 7 days–72 months). Abdominal pain, nausea and vomiting were the most common complaints. White blood cell count was increased to a mean of 64 mg/dl (range 45–155 mg/dl) in 6 patients. CT scan showed signs of intestinal obstruction in all 7 patients with acute presentation. Surgery was done by laparoscopy in 5 cases (2 in the setting of emergency), and by laparotomy in the remaining 5 cases. All IHs were located at the mesenteric defect and were treated with IH reduction in all but one patient who underwent small bowel resection. There was no mortality, and one patient had pneumonia with acute respiratory distress syndrome that resolved favorably. Conclusions IH after LRYGBP occurred mainly at the mesenteric defect and in patients with no closure of the defect. The antecolic approach for the Roux-limb, the division of the greater omentum only when too thick, and the systematic closure of the defects with tight non-absorbable running sutures are recommended.     

成人腹股沟疝囊内面病理及细菌学观察

目的 探讨腹股沟疝疝囊局灶性增厚是否和细菌感染有关。方法 选取2015年6月至2016年12月于中山大学附属第六医院收治诊断为腹股沟疝患者68例（男56,女12）,腹腔镜直视下观察并记录疝囊形态。根据疝囊有无增厚分为增厚组（37例）和光滑组（31例）,观察比较两组标本的组织结构成分和炎性细胞计数,并用实时荧光定量PCR方法检测其中是否存在细菌DNA。结果 疝囊内侧面增厚的出现率为66.1%（37/68）,与病程（病程<1年39.1%,病程1~5年46.1%,病程>5年84.2%）和既往嵌顿史（75% vs. 45.8%）、粘连（95% vs. 37.5%）相关。显微镜下观察增厚疝囊组织可见纤维结缔组织增厚,并见较多炎性细胞浸润（中性粒细胞15.2±2.3 vs. 2.5±0.7,淋巴细胞35.3±1.9 vs. 12.8±1.4,浆细胞2.6±0.6 vs. 1.5±0.4,总计数53.1±1.3 vs. 16.8±1.2,P值均<0.05）,毛细血管扩张（67.6% vs. 25.8%,P<0.05）。增厚组发现2例大肠杆菌DNA表达阳性,光滑组1例阳性。结论 腹股沟疝,尤其是病程长、有嵌顿史的可能存在局部细菌感染。     

Torsion of an indirect hernia sac causing acute scrotum

A 6-year-old boy presented with an acute scrotum and was found at surgical exploration to have torsion and infarction of an indirect hernia sac. This represents the sixth reported case of this entity in the literature. The pediatric surgical specialist and those in the acute care setting should be aware of this consideration in the differential diagnosis of the acute scrotum.     

Internal supravesical hernia

Internal supravesical hernia is a rare cause of intestinal obstruction and a clinical diagnostic problem. We demonstrate its computed tomography (CT) appearance and believe familiarity with the anatomy of the supravesical fossa may allow the preoperative diagnosis.     

A case of intestinal obstruction due to a hernia traversing the lesser sac

A case of a hernia traversing the lesser sac with a primary defect in the greater omentum and a secondary defect in the lesser omentum is reported herein. This type of internal hernia is extremely rare and we have found only three other reported cases apart from our case. All four cases in whom this type of hernia occurred were young people. The general manifestation resembles acute intestinal obstruction and a plain radiograph shows obstruction of the upper small intestine. An erect lateral view of the abdomen often shows the anatomical location more clearly. Bowel resection was performed in two cases and all of the four reported cases recovered uneventfully.     

Internal hernia of the small bowel after right-lobe live donor liver transplantation

Internal hernia of small bowel is an uncommon but potentially fatal complication of liver transplantation. We report on four patients in whom internal hernia of small bowel occurred after right-lobe live donor liver transplantation (LDLT). Three patients had small bowel herniation with volvulus around the Roux-en-Y loop whereas the other patient had herniation through the mesenteric window of transverse mesocolon after hepaticojejunostomy for biliary reconstruction. Based on clinical and radiologic findings, early diagnosis was made in all cases. All patients survived following surgical reduction of the hernia and closure of the mesenteric defect without bowel resection. Transplant surgeons should be aware of this serious complication so that early diagnosis and appropriate operative intervention can be made. The complication can be avoided with duct-to-duct biliary reconstruction or meticulous closure of all mesenteric defects with non-absorbable suture materials after hepaticojejunostomy in patients undergoing right-lobe LDLT.     

Primary peritoneal adenocarcinoma detected within a femoral hernia sac

We report on a case of primary peritoneal adenocarcinoma diagnosed after histological examination of a femoral hernia sac. To the best of our knowledge, this is the first reported case of primary peritoneal adenocarcinoma detected incidentally during repair of a femoral hernia.     

疝囊主动切开技术在腹股沟斜疝腹腔镜完全腹膜外疝修补术中的应用

目的探讨疝囊主动切开技术在成人腹股沟斜疝腹腔镜完全腹膜外疝修补术（TEP）中的应用价值及临床效果。 方法回顾性分析2018年3月至2020年7月在洪湖市人民医院行腹股沟斜疝TEP手术的225例患者的临床资料,按照疝囊分离方式不同分为2组。观察组患者103例,采取疝囊主动切开分离技术;对照组患者122例,采取疝囊剥离技术。对比分析2组患者手术时间、术后住院时间、术后12 h疼痛评分、手术室费用、术中副损伤（输精管、精索血管、肠管）、并发症发生率（血清肿、切口感染、慢性疼痛）等临床指标。 结果2组患者手术均顺利完成,无中转开放。观察组手术时间[（50.2±12.6）min]较对照组[（65.6±18.1）min]显著缩短,差异有统计学意义（P<0.05);2组患者术后住院时间、术后12 h疼痛评分、手术室费用比较,差异均无统计学意义（P>0.05）;观察组较对照组术中副损伤明显减少,但是血清肿发生率明显增加,差异有统计学意义（P<0.05）。术后均随访6个月,2组患者均无肠梗阻、复发、慢性疼痛及补片感染等严重并发症发生。 结论TEP术中主动切开疝囊缩短了手术时间,其操作简单、安全可行,不会影响手术空间,尤其适用于病程较长或粘连严重的疝囊分离困难患者。     

腹腔镜腹股沟直疝修补术中假性疝囊处理的临床研究

目的探讨腹股沟直疝经全腹膜外修补术中个体化手术方式固定假性疝囊的临床疗效。 方法选择2014年1月至2016年1月,湖北医药学院附属太和医院收治106例腹股沟直疝患者的临床资料,由随机数字表法随机分成固定组（53例）与常规组（53例）。术后随访2年,分别观察2组手术时间、术后第1和3天疼痛评分、术后住院时间、住院费用及术后并发症（血清肿、局部异物感、阴囊肿胀、伤口感染、腹股沟区慢性疼痛）发生率、术后2年疝复发率。 结果2组患者的手术时间、术后第1和3天疼痛评分和住院时间及住院费用比较,差异无统计学意义（P>0.05）。固定组血清肿及局部异物牵拉感的发生率较常规组显著减少,差异有统计学意义（P<0.05）,而在阴囊肿胀、伤口感染、术后腹股沟区慢性疼痛并发症发生率方面比较,差异无统计学意义（P>0.05）。随访2年,2组均无疝复发。 结论腹腔镜腹股沟直疝修补术中采用固定直疝假性疝囊可有效减少术后血清肿及术区异物牵拉感,是一种安全、经济、有效的固定方法。     

Torsion of the hernia sac within a hydrocele of the scrotum in a child

Torsion of the hernia sac is a rare disease that presents as acute scrotum in children. Including the present case, only six cases have been reported in the English literature. We report a 10-year-old boy who presented with pain and swelling of his right scrotum. Ultrasonography revealed a hypoechoic region adjacent to the normal right testis. The inflammatory changes of the right scrotum deteriorated. The patient underwent surgery and a necrotic cyst was recognized within a hydrocele of the scrotum. The cyst was not connected with the testis or epididymis and was twisted at an angle of 270 degrees. The cause of the necrotic cyst observed was anatomical and pathological torsion of the hernia sac.