Internal Hernias: Clinical Findings, Management, and Outcomes in 49 Nonbariatric Cases

Abstract

Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%. Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly, internal hernias can be repaired with acceptable morbidity and mortality.

Internal herniation of the caecum into the lesser sac: an unusual cause of an acute abdomen (2009: 10b)

“…As such, the clinical diagnosis is often delayed, only becoming apparent once the herniated bowel becomes strangulated or incarcerated. This delay in diagnosis can result in the development of gangrenous bowel requiring surgical resection, and this has been reported in 64% (n=9/14) of cases of internal hernia in one series and 22% (n=11/49) of cases in another [6][7][8].…”

Spontaneous Transomental Hernia Combined with Incarcerated Inguinal Hernia: A Case Report

“…Therefore, for the treatment of TOH, emergency surgery must be attempted as soon as possible. However, the preoperative diagnosis of TOH is difficult because clinical manifestations are nonspecific, as compared with other causes or types of strangulated SBO [3][4][5][6]11]. As a result, precise diagnosis in most TOH cases, as in our case, is made during emergency surgery for strangulated SBO [3][4][5][6].…”

“…Internal hernia is a characteristic condition of SBO, in which a loop of the small bowel herniates through a congenital or acquired peritoneal or mesenteric aperture within the abdominal cavity, resulting in strangulation of the herniated bowel [1,[7][8][9][10][11]. Internal hernia is an unusual cause of SBO, accounting for only 0.6-5.8% of total SBO cases [7].…”

Internal Herniation Due to Appendix Vermiformis Rotation: A Rare Case of an Acute Abdomen

“…The clinical symptoms may range from mild abdominal pain to acute abdomen. The fact that the symptoms are generally non-specific during the period up to the formation of the strangulation increases the possibility of ischemia in the intestines and since delays in early diagnosis bring about ischemia due to strangulation, mortality and morbidity rates increase (2,4,5). The patient in our case had herniated small bowel and the symptoms of small bowel obstruction and we performed intestinal resection because of strangulation.…”