Computed Tomographic Appearance of Internal Herniation Through the Sigmoid Mesocolon

The case of a patient with surgically proven internal herniation of a loop of ileum through the sigmoid mesocolon is described. This 66-year-old man presented clinically with acute lower abdominal pain and an elevated white blood cell count. A computed tomography (CT) scan showed a thickened bowel loop with “bird-beak” appearance in the pelvis, centered towards the medial side and lying aside the effaced sigmoid colon. We think this CT picture is highly suggestive of internal herniation of the ileum through the sigmoid mesocolon, which is a rare clinical entity

Intersigmoid hernia. A forgotten diagnosis, a systematic review of the literature over anatomical, diagnostic, surgical, and medicolegal aspects

Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods. In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. &e purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results. &e diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1–10 cm, SD 1.15 cm) and the length of the incarcerated small intestine was between 3 cm (min) and 150 cm (max): mean 25.25 cm, SD 35.04 cm. &e diameter of the sigmoid recess was greater in patients who underwent resection due to strangulation (mean 3.31 cm, SD 1.53 cm) compared to those who underwent only reduction of the hernia (mean 2.35 cm, SD 0.74 cm). &e time from onset to operation was less in patients undergoing resection surgery due to throttling (mean 3.03 days, SD 3.01 days) compared to those who underwent only a reduction of hernia incarceration (mean 8.49 days, SD 6.83 days). Conclusion. Intersigmoid hernia is often a forgotten diagnosis and a clinical challange due to its anatomical characteristics

A case of a paraduodenal hernia with a concomitant mesosigmoid defect

Abstrac

Transmesocolic hernia with sigmoid colon strangulation without surgical history: a series of two case reports.

The incidence of internal hernias is rare (0.2-0.9%). The prevalence of intestinal obstruction for an internal hernia is low (0.5-5%), however if strangulation is present the overall mortality is higher than 50%. There are multiple places where an internal hernia may be localized, with transmesenteric: transmesocolic (8%) and transomental (1-4%) as the rarest. We report a series of two cases (men with 40 years-old and women with 92 years old) of volvulus of colon sigmoid in a strangulated transverse and descendent transmesocolic hernia, with one case associated also to a transomental hernia. Both patients were submitted to a Hartmann procedure and on follow-up remained free of complains. In conclusion, transmesenteric internal hernia should be included as diagnosis hypothesis for intestinal occlusion and if the diagnosis is made, the patient should be submitted to emergency surgery due to high rates of complications, high morbidity and mortality.info:eu-repo/semantics/publishedVersio

Computed tomography findings of intersigmoid hernia

Purpose: To evaluate the computed tomography findings of intersigmoid hernias. Material and methods: Between April 2010 and March 2018, 7 patients who were surgically diagnosed with intersigmoid hernia in 3 institutions were enrolled in this study. Two radiologists evaluated imaging findings for the herniated small bowel, the distance between the occlusion point and bifurcation of the left common iliac artery, and the anatomic relationship with adjacent organs. Results: All patients were male, and their mean age (standard deviation, range) was 61.0 (13.5, 36-85) years. The mean size of the bowel loops was 5.2 (1.3, 4.0-8.3) cm in the caudal direction, 3.6 (0.8, 2.5-5.1) cm in the lateral, and 3.4 (0.6, 2.5-4.7) cm in the anterior-posterior direction. The volume was 37.9 (27.8, 15.6-103.0) cm3 approximated by an ellipse, and 24.0 (17.7, 9.9-65.6) cm3 approximated by a truncated cone. The obstruction point was located 3.6 (0.6, 2.8-4.7) cm inferior to the bifurcation of the left common iliac artery. In all cases, the small bowel ran under the point at which the inferior mesenteric vessels bifurcated to the superior rectal vessels and the sigmoid vessels and formed a sac-like appearance between the left psoas muscle and the sigmoid colon. The ureter ran dorsal to the point of the bowel stenosis, and the left gonadal vein ran outside the small bowel loops. Conclusions: All cases showed common imaging findings, which may be characteristic of men's intersigmoid hernia. In addition, the fossa's position was lower, and the size was larger than in the previous study, which may be a risk factor

Incarcerated transmesosigmoid hernia presenting in a 60-year-old man: a case report

© 2008 Collins et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Intra peritoneal ascending colon in parastomal hernial sac

The rate of parastomal hernia reported varies from 5% to 80%. It forms when the abdominal wall defect is continually stretched by the tangential forces applied along the circumference of the abdominal wall opening. The presence of parastomal hernia along with intraperitoneal ascending colon, caecum and terminal ileum along with ileal perforation is a rare entity

Transmesocolic Hernia of the Ascending Colon with Intestinal Obstruction

An internal hernia may be either congenital or acquired. The reported incidence of such hernias is 1–2%. In rare cases, internal hernias are the cause of small bowel obstruction, with a reported incidence of 0.2–0.9%. Transmesocolic hernia of the ascending colon is especially rare. We report a case of transmesocolic hernia of the ascending colon with intestinal obstruction diagnosed preoperatively. A 91-year-old Japanese female was admitted to our hospital with abdominal distention and vomiting of 3 days duration. She had no past history of any abdominal surgery. Abdominal examination revealed distention and tenderness in the right iliac fossa. Abdominal computed tomography revealed ileus in the sac at the left side of the ascending colon and dilatation of the oral side of the intestine. We diagnosed a transmesocolic hernia of the ascending colon with intestinal obstruction and performed emergency surgery. At the time of operation, there was internal herniation of ileal loops through a defect in the ascending mesocolon, without any strangulation of the small bowel. The contents were reduced and the tear in the ascending mesocolon was closed. The postoperative course was uneventful and the patient was discharged 14 days after surgery. In conclusion, preoperative diagnosis of bowel obstruction caused by a congenital mesocolic hernia remains difficult despite the techniques currently available, so it is important to consider the possibility of a transmesocolic hernia when diagnosing a patient with ileus with no past history of abdominal surgery

Obstructive right paraduodenal hernia: A case report

Intestinal obstruction is a prevalent condition in rural Kenya. Common aetiologies include sigmoid volvuli, strangulated hernias, intussusception and in children, congenital gut malformations. Paraduodenal hernia causing intestinal obstruction has not been encountered in our practice

Analytical study of Acute Intestinal Obstruction – Large Intestine Vs Small Intestine

INTRODUCTION: Acute intestinal obstruction continued to be a emergency presentation till date. It is one of the gravest emergencies presenting to the surgeon in all aspects. It was said by Berkeley Moynihans in 1926 “when called upon to deal with a case of acute intestinal obstruction the surgeon is confronted with of the gravest and most disastrous emergencies. The patient may be, and often is, a man or woman in the prime of life, in full enjoyment of vigorous health, who, without, warning, is suddenly seized with the most intolerable pain in the abdomen…..” Physical signs and their interpretation reach very much of importance in the diagnosis. It is one of the emergencies where as quickly as possible we act, the result will be remarkable. This fact was indicated by Sir Heneage Ogilvie that “in the acute abdominal emergencies the difference between the best and worst surgery is infinitely less than that between early and late surgery, and greatest sacrifice of all is the sacrifice of time” more apt in the present context. AIM OF THE STUDY: 1. To evaluate the common causes of acute intestinal obstruction in this region. 2. To identify the aetiopathogenesis. 3. To evaluate the various modes of presentation. 4. To study the various modalities of treatment in this centre. 5. To evaluate the morbidity and mortality of acute intestinal obstruction. 6. Causes may vary in acute intestional obstruction in different cases. MATERIALS AND METHODS: A total of 90 cases of acute intestinal obstruction admitted in all surgical wards, Thanjavur Medical College Hospital, Thanjavur, over a span of 1 year form October 2014 – October 2015. Both men and women more than 15 years of age totaling 60 cases with features of acute intestinal obstruction were chosen. The paediatric patients were not included in this study. The Age, Sex detailed History relevant to the etiology were noted. The characteristic clinical features of acute intestinal obstruction were abdominal pain, vomiting, constipation/obstipation, Abdominal distension and clinical signs including Fever (>37.2C). Tachycardia (>100/mt), Palpable abdominal mass if any were noted. All the patients were subjected to investigation while resuscitative measures were on progress: 1. Urine – albumin, sugar, 2. Hb%, 3. Blood Grouping with typing, 4. WBC count 5. Blood – urea, sugar, 6. Serum Creatinine, Electrolytes – in cases with severe dehydration. 7. X – ray chest PA view, 8. ECG, 9. Plain X-ray abdomen erect and supine position and results were recorded. After adequate preoperative preparation, all patients were subjected to surgical procedures appropriate to the condition and preoperative pathology were noted. The etiological incidence, Sex incidence, Age incidence, incidence of strangulation, value of plain X-ray Abdomen in diagnosis of acute intestinal obstruction, importance of early treatment were studied. CONCLUSION: 1. Among the causes of Acute Intestinal obstruction, 78.16% is contributed by Small bowel obstruction and 21.84% by Large bowel obstruction. 2. The major cause of acute intestinal obstruction is still External hernia (48.03%) here. Among this, inguinal hernia alone accounts for 81.82% in total. 3. Even though the inguinal hernia causing obstruction is highly prevalent, the Strangulation rate comes down dramatically to 13.33% (12) cases. 4. Adhesive obstruction accounts for 18.78% in total, of which the Postsurgical adhesion is the major cause. 5. Sigmoid volvulus ranks fourth in etiology of acute intestinal obstruction contributing 9.61%, next only to large bowel neoplasms contributing 10.48%. 6. Sigmoid volvulus contributes to large bowel obstruction accounting for 44 % and Neoplasm contributes to 48 % only. 7. Clinical parameters fail to differentiate between simple and strangulated obstruction exactly. 8. Plain X-ray abdomen is a valuable in the diagnosis of the acute obstruction (73%) and hence it is considered as minimal investigation before surgery. 9. Early surgical intervention and antibiotics has reduced the mortality of the simple bowel obstruction. 10. In Strangulated obstruction, the mortality rate is still significantly more, due to age, associated diseases and late arrival to hospital. 11. Mortality associated with large bowel obstruction is 14% compared to 7.26% with small bowel obstruction. 12. Early diagnosis and early surgical intervention is the key to reduce the mortality