Internal hernia caused by epiploic appendices successfully treated by single-incision laparoscopic surgery (SILS)

Abstract

Internal hernia is a rare and often overlooked cause of small bowel obstruction. We report a case of internal hernia with an orifice composed of epiploic fat, successfully diagnosed and treated by single-incision laparoscopic surgery. This is the second report of this type of internal hernia and the first reported case addressed laparoscopically. Although the use of laparoscopy for the treatment of small bowel obstruction is not firmly established today, it may be beneficial for both its diagnostic value and as a less invasive treatment.

An unusual case of intestinal obstruction due to internal herniation from adhesions between two appendices epiploicae

“…To the best of our knowledge, an internal herniation because of an adhesion between the tips of two appendices epiloicae has never been reported before. We found less than five cases of internal herniation caused by adhesions between appendicices epiploicae and surrounding omentum [ 1 , 2 ]. We presume that in this patient who was previously not operated, mild inflammation in the appendices must have lead to adhesions and herniation.…”

“…Intestinal obstruction occurring due to internal herniation of bowel is very rare. Internal herniation occurring due to appendices epiploicae is even more uncommon with less than five reported cases in literature [ 1 , 2 ]. Epiploic appendages or appendices epiploicae are peritoneum-lined protrusions of subserosal fat that arise from the surface of the colon.…”

Single-port surgery (SPS) strategy for small bowel obstruction (SBO) caused by postoperative internal hernia

“…To our knowledge, the usefulness of SPS for SBO with internal hernia has been indicated by only a few reports. [ 1 , 3 , 7 , 8 ] The reasons why laparoscopic surgeries including SPS for SBO are not widely used might be the following: the operation space is limited, identification of the obstruction site is relatively difficult, the expanded bowel might easily be injured. However, SPS should be more frequently applied to SBO situations because it is a relatively easy approach, requires only an incision at the umbilicus even in multi-adhesion cases, and can be performed without making an additional space for a trocar.…”

“…[ 2 ] However, in the case of SBO, surgeons tend to hesitate to perform laparoscopic surgery, including SPS, because of the risk of intraoperative complication such as iatrogenic bowel injury due to poor manipulation space or bowel weakness. [ 1 , 3 ] Herein, we report our techniques and strategy using SPS as a diagnostic tool for initial surgical management for suspected SBO with postoperative internal hernia and show 3 SBO cases in which SPS was applied for postoperative internal hernias.…”

A Rare Case of Intestinal Obstruction from Internal Hernia through a Foramen Formed by Appendices Epiploicae – A Case Report and Review of Literature

“…Herniation of the viscous may be through a normal anatomical aperture or an abnormal one within the peritoneal cavity. Internal hernia resulting from the appendices epiploicae is extremely rare with only six cases reported in the literature [3], [4], [5], [6], [7], [8].…”