Internal Abdominal Herniations

Mathieu, Didier; Luciani, Alain

doi:10.2214/ajr.183.2.1830397

Cited by 144 publications

(122 citation statements)

References 14 publications

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“…6 Symptoms range from mild dyspepsia and nonlocalized abdominal pain to nausea and emesis. 1,[5][6][7][11][12][13] Postprandial abdominal pain and changes in pain based on body position have also been reported. 2,9 These symptoms often resolve with spontaneous reduction of the hernia.…”

Section: Figurementioning

confidence: 98%

“…5,15,16 The most consistently reported signs in the literature that suggest the presence of a PDH are as follows: the presence of bowel between the stomach and pancreas or the transverse colon and left adrenal gland, displacement of the IMV upward and anteriorly, and presence of an encapsulated bowel sac lateral to the duodenum. 5,7,[9][10][11]13,15,[17][18][19] Despite the presence of well-reported diagnostic criteria, many nonobstructive IHs go undiagnosed or misdiagnosed. 5,20 It is important to note that these radiographic findings can be subtle, and a lack of awareness likely contributes to missed diagnoses.…”

Section: Figurementioning

confidence: 99%

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Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

Shi¹,

Felsted²,

Masand³

et al. 2015

Pediatrics

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Paraduodenal hernias are the most common type of congenital internal hernia. Because of its overall rare incidence, this entity is often overlooked during initial assessment of the patient. Lack of specific diagnostic criteria also makes diagnosis exceedingly difficult, and the resulting diagnostic delays can lead to tragic outcomes for patients. Despite these perceived barriers to timely diagnosis, there may be specific radiographic findings that, when combined with the appropriate constellation of clinical symptoms, would aid in diagnosis. This patient first presented at 8 years of age with vague symptoms of postprandial emesis, chronic abdominal pain, nausea, and syncope. Over the span of 6 years he was evaluated 2 to 3 times a year with similar complaints, all of which quickly resolved spontaneously. He underwent multiple laboratory, imaging, and endoscopic studies, which were nondiagnostic. It was not until he developed signs of a high-grade obstruction and extremis that he was found to have a large left paraduodenal hernia that had volvulized around the superior mesenteric axis. This resulted in the loss of the entire superior mesenteric axis distribution of the small and large intestine and necrosis of the duodenum. In cases of chronic intermittent obstruction without clear etiology, careful attention and consideration should be given to the constellation of symptoms, imaging studies, and potential use of diagnostic laparoscopy. Increased vigilance by primary care and consulting physicians is necessary to detect this rare but readily correctable condition.Internal hernias (IHs) are a rare clinical entity that cause 0.6% to 5.8% of small bowel obstructions. 1 There are 2 broad categories of IH: acquired and congenital. These are further categorized by location, which include paraduodenal, transmesenteric, and supra-or perivesical IHs and those located at the Foramen of Winslow. 2,3 Paraduodenal hernias (PDHs) are thought to be the most common type of congenital IH. 2,3 However, with the increasing incidence of procedures that require Roux-en-Y reconstruction, such as gastric bypass surgery, Kasai, choledochal cyst excision, and pediatric liver transplantation, the incidence of acquired IH is increasing. 4 Left PDH refers to a herniation of the small bowel into a mesenteric defect to the left of the inferior mesenteric vein (IMV) with a hernia sac within the leaflets of the left colon mesentery. 5 Symptoms can range from intermittent partial bowel obstruction in cases of spontaneously reducing IH to acute high-grade obstruction that occurs with incarceration or volvulus. 6 Radiographic diagnosis is made difficult because of the often intermittent nature of the disease, in which spontaneous reduction in and resolution of symptoms can occur by the time diagnostic imaging is performed. 2,7 Even when present, Dr Shi drafted the initial manuscript; Ms Felsted assisted in drafting the initial manuscript; Dr Masand provided radiographic expertise, drafted the figure legends, and reviewed and revised the ma...

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Section: Figurementioning

confidence: 98%

Section: Figurementioning

confidence: 99%

Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

Shi¹,

Felsted²,

Masand³

et al. 2015

Pediatrics

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“…Internal hernias most commonly present as acute small bowel obstruction with severe pain, abdominal distention and vomiting. However, if the hernia is able to reduce spontaneously, the pain may be mild and transitory [1][2][3][4]7 . During this time, physical and clinical examination may be unremarkable 2,7 .…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have described the findings of conventional radiographs 6 . Most commonly, distended bowel loops with air-fluid levels are seen in the middle upper abdomen, medially and posteriorly to the stomach 1,2,4,7 . If the ascending colon and cecum are involved, the right iliac fossa will appear empty 2,6,7 .…”

Section: Introductionmentioning

confidence: 99%

Ileal Herniation Through the Foramen of Winslow: Overeating as a Risk Factor for Internal Herniation

Kirigin

Nikolić

Kruljac

et al. 2016

ACC

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SUMMARY -Internal hernias have an overall incidence of less than 1% and are difficult to diagnose clinically due to their nonspecific presentation. Most internal hernias present as strangulating closed-loop obstruction and delay in surgical intervention is responsible for a high mortality rate (49%). We present a case of ileal herniation through the foramen of Winslow. A 29-year-old previously healthy female presented with acute onset right upper quadrant pain, abdominal fullness, and nausea. The pain was sudden in onset and began shortly after a dinner party where she consumed larger portions of food. Laboratory investigations revealed mild leukocytosis with left shift. Dual-phase multi-detector computed tomography disclosed herniation of the small bowel into the lesser sac. The patient underwent an emergency median laparotomy that revealed ileal herniation through the foramen of Winslow. Adhesiolysis and manual reduction of the bowel was performed, and the reduced bowel showed only congestive changes. The postoperative recovery was uneventful and the patient was discharged on the third postoperative day. Risk factors for internal herniation still remain unclear, although excessively mobile bowel loops and an enlarged foramen of Winslow have been described. Our case demonstrated that overeating could be an additional risk factor for internal herniation. We describe our clinical and radiology findings, as well as surgical management. Due to the high rates of morbidity and mortality, it is imperative that clinicians be aware of the possible risks factors for internal herniation. Internal hernias should be included in the differential diagnosis of small bowel obstruction so that appropriate steps can be made in the work-up of these patients, followed by timely surgical intervention.

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“…In addition internal hernias due to congenital abnormalities or surgical defects in the mesentery causing bowel obstruction are very rare [1].…”

Section: Introductionmentioning

confidence: 99%

An Interesting Case of Intestinal Obstruction

Kumar

Joshi

2007

Medical Journal Armed Forces India

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Internal Abdominal Herniations

Cited by 144 publications

References 14 publications

Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

Ileal Herniation Through the Foramen of Winslow: Overeating as a Risk Factor for Internal Herniation

An Interesting Case of Intestinal Obstruction

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