A Rare Type of Primary Internal Hernia Causing Small Intestinal Obstruction

Abstract

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.

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

“…This leads diagnostic delays and increases in rates of ischemia, gangrene, and bowel resection. 7 Computed tomography (CT) at present plays an important role in the evaluation of intestinal obstruction and acute abdomen. Both X-ray and ultrasonography are poor in detecting the etiology of intestinal obstruction.…”

“…It determines the etiology as well by identifying internal hernias and extra luminal lesions, such as masses, adenopathy, soft tissue infiltration, and vascular anomalies. 7 Timely surgical intervention based on clinical suspicion and CT scan findings is necessary for the management of IH presenting with intestinal obstruction. Reduction of the strangulated intestinal segment should be done as early as possible to prevent intestinal ischemia, necrosis, and perforation and thereby reduce resection rates.…”

Small intestinal perforations due to acquired internal herniation

“…The surgical treatment results for congenital types were also much better than the results for acquired types [12][13][14][15]. Delayed laparotomy time (>3 days after the onset of the symptoms) and the presence of a comorbidity were related to high morbidity [16]. In acquired IHs, transmesenteric hernias are increasing in incidence, and also, they are more likely to develop volvulus and strangulation or ischemia and perforation [17][18][19].…”

A Strangulated Trans Mesenteric Hernia- An Unusual Case of Acute Abdomen

“…Trans mesenteric hernias are even rarer constituting 5% to 10% of causes of internal hernia. [7] Nearly, 35% of trans mesenteric hernia manifests in the paediatric age group, in which they constitute the most common type of internal hernia. Hensing in 1742 was the first to describe surgical anatomy of some varieties of internal hernia.…”