Small Intestinal Strangulation Due to a Rare Type of Primary Internal Hernia

Abstract

Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.Key words: Internal hernia -Paracolic gutter A n internal hernia is a rare condition defined as the protrusion of abdominal viscera into one of the fossae, foramina, recesses, or congenital defects within the abdominal and pelvic cavity. Internal hernias are generally classified into 6 types: paraduodenal, pericecal, foramen of Winslow, transmesenteric, pelvic and supravesical, and intersigmoid. 1-3A pericecal hernia is a typical form of internal hernia and can be divided into 4 types: superior ileocecal recess, inferior ileocecal recess, retrocecal recess, and paracolic sulcus.2 Although our case displayed similar features to the paracolic sulcus type of pericecal hernia, it differed from a pericecal hernia in that the hernia gate was located along the right

A Rare Type of Primary Internal Hernia Causing Small Intestinal Obstruction

“…Congenital internal abdominal hernias (CIAH) are either retroperitoneal or formed from congenital anomalous openings lacking a true peritoneal sac. Retroperitoneal hernias are further classified by Ghahremani into paraduodenal (30–53% of CIAH), foramen of Winslow (6%–10%), pericecal (10%–15%), intersigmoid (4%–8%), pelvic, and paravesical hernias (6%), whereas hernias formed from congenital anomalous openings can be categorized as transmesenteric (8%–10%), broad ligament (4–7%), or transomental hernias (1–4%) [5]. In our case, a retroperitoneal hernia was located in the left paracolic gutter lateral to the sigmoid colon.…”

“…In our case, a retroperitoneal hernia was located in the left paracolic gutter lateral to the sigmoid colon. Thorough MEDLINE search revealed only few case reports of IH with the gate located in the paracolic gutter adjacent to the colon [5, 6]. These types have not been included in the current classification.…”

Internal hernias: Emergency department radiological dilemma

“…In the reality, we know that 5.8% cases of small bowel obstruction are due to internal hernia [4]. Internal herniation should be considered as a differential diagnosis in patients presenting with symptoms of small bowel obstruction without a history of prior abdominal surgery.…”

“…Congenital and acquired defects in the mesentery of the cecum or appendix, may lead to development of a pericecal hernia. Anatomically, there are four types of peritoneal recesses of various sizes and depths identified in the pericecal region, including the superior ileocecal recess, inferior ileocecal recess, retrocecal recess and paracolic sulci [4,5]. Internal abdominal hernias present a non-specific and intermittent clinical presentation.…”

Hernia transmesentérica. Revisión del tema a raíz de un caso exótico de infarto intestinal en un adulto

“…Puede ir desde una leve molestia abdominal, asociada a diarrea y vómito, hasta casos muy graves de dolor abdominal severo, choque y muerte súbita (36,37). En ocasiones, puede ser un hallazgo casual (38) o desencadenar síntomas después de un evento abdominal traumático (39).…”