Internal hernia is the protrusion of a viscus through a normal or abnormal peritoneal or mesenteric aperture within the confines of the peritoneal cavity. They can be congenital or acquired after abdominal surgery. We report a case of a 58-year-old woman who presented with complaints of abdominal pain and nonbilious vomiting for 2 days. She underwent an abdominal hysterectomy 15 years ago. After baseline blood investigations and imaging, a diagnosis of subacute intestinal obstruction was made. As she clinically worsened over 24h, CT imaging was done, which suggested acute small bowel obstruction secondary to adhesions. Surgery revealed herniation with incarceration of distal ileal loops through a defect in the sigmoid mesocolon. Bowel resection was done, and the defect was closed. The clinical presentation of internal hernias, especially transmesosigmoid hernia, is nonspecific, and they rapidly progress to bowel ischemia. Early intervention and surgical correction are prudent for good clinical outcomes.
| [1] |
Ghahremani GG . Internal abdominal hernias. Surg Clin North Am 1984; 64: 393- 406.
|
| [2] |
Newsom BD , Kukora JS . Congenital and acquired internal hernias: unusual causes of small bowel obstruction. Am J Surg 1986; 152: 279- 85.
|
| [3] |
Blachar A , Federle MP . Bowel obstruction following liver transplantation: clinical and CT findings in 48 cases with emphasis on internal hernia. Radiology 2001; 218: 384- 8.
|
| [4] |
Blachar A , Federle MP , Pealer KM , Ikramuddin S , Schauer PR . Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology 2002; 223: 625- 32.
|
| [5] |
Meyers MA . Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy. 4th ed. New York, NY: Springer-Verlag; 1994.
|
| [6] |
Janin Y , Stone AM , Wise L . Mesenteric hernia. Surg Gynecol Obstet 1980; 150: 747- 54.
|
| [7] |
Benson JR , Killen DA . Internal hernias involving the sigmoid mesocolon. Ann Surg 1964; 159: 382- 4.
|
| [8] |
Johnson BL , Lind JF , Ulich PJ . Transmesosigmoid hernia during pregnancy. South Med J 1992; 85: 650- 2.
|
| [9] |
Li B , Assaf A , Gong YG , Feng LZ , Zheng XY , Wu CN . Transmesosigmoid hernia: Case report and review of literature. World J Gastroenterol 2014; 20: 5924- 9.
|
| [10] |
Yu CY , Lin CC , Yu JC , Liu CH , Shyu RY , Chen CY . Strangulated transmesosigmoid hernia: CT diagnosis. Abdom Imaging 2004; 29: 158- 60.
|
RIGHTS & PERMISSIONS
International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow
PDF
(2022KB)
