Intersigmoid hernia: Report of a case

Abstract

A 28-year-old man with no previous history of abdominal surgery presented at a local hospital with abdominal pain. He was diagnosed to have an intestinal obstruction and was treated conservatively. However, the symptoms persisted, and he was thereafter referred to this hospital. Plain abdominal radiographs demonstrated small-bowel gas. A computed tomographic scan of the abdomen disclosed wall thickening of an edematous, fluid-filled ileum. An exploratory laparotomy was performed to determine the cause of the intestinal obstruction. The ileum had herniated into the intersigmoid fossa, 100 cm proximal to the ileocecal valve, and the patient was diagnosed to have an intersigmoid hernia. Since the incarcerated portion of the small bowel was viable, reduction of the hernia and closure of the defect in the sigmoid mesocolon were performed. The postoperative course was uneventful. A sigmoid mesocolon hernia is an uncommon condition. This report presents a case of intersigmoid hernia and a review of 60 cases of sigmoid mesocolon hernia reported in Japan.

Laparoscopic Repair of Incarcerated Intersigmoid Hernia

“…Indeed, previous attempts at nonoperative management of incarcerated intersigmoid hernias have been unsuccessful. 1,2 In these previously reported cases, laparotomy was eventually required and the length of stay was 8 days, compared with 36 hours after the laparoscopic repair in the present case.…”

“…Although historically an intersigmoid hernia was thought to be most common subtype, 4 a recent literature review suggests that intramesosigmoid hernia is the most common. 1 Internal hernias are the cause of small intestinal obstruction in less than 4% of cases. 2 The incidence is much higher, however, after gastric bypass surgery.…”

“…Making a diagnosis of intersigmoid hernia causing small-bowel obstruction can be difficult and is usually made during laparotomy. 1 This is the first reported case of the complete laparoscopic reduction and repair of an incarcerated intersigmoid hernia, and a method of management is described along with a discussion on the role of laparoscopy in acute small-bowel obstruction.…”

Usefulness of Oblique Multiplanar Images on Multi-Detector Computed Tomography for Diagnosing Intersigmoid Hernia

“…The rate of bowel resection is higher in those patients with transmesosigmoid hernia (50%) than in those with intersigmoid hernia (18.8%) or intramesosigmoid hernia (13.9%) because the herniated loop of the bowel is often long and easily causes strangulation, leading to intestinal necrosis [5]. In contrast, in patients with intersigmoid hernia, the incarcerated loop is very short as the sigmoid fossa only builds a small cavity; therefore, circulatory disturbance seldom occurs.…”

“…However, in the case of intersigmoid hernia, the space of the intersigmoid fossa is not very large - from a mere dimple to a size that will admit the whole index finger -, with the possibility of contained bowels in the fossa being limited, and therefore detection of the incarcerated bowel is difficult. Nihon-Yanagi et al [5] reported a case of intersigmoid hernia. In their patient, CT could disclose an enlarged fluid-filled ileum with an edematous wall in the left iliac fossa and pelvic cavity.…”