Lesser omental hernia without intestinal gangrene - Case report

INTRODUCTION: There are several types of internal hernia. Herniation through the defect in the lesser omentum is extremely rare. Symptoms of this type of hernias may vary a lot and diagnosis is difficult. In this case report a young adult with nonspecific symptoms is diagnosed with an intestinal herniation through the defect in the lesser omentum. CASE PRESENTATION: A 35-year-old man with the history of laparoscopic colectomy presented with abdominal pain but no symptoms of peritonitis or acute bowel obstruction. Abdominal computed tomography (CT) revealed displacement of mesenteric vessels, small intestine and stomach. Intestinal herniation through the lesser omentum was suspected. Laparoscopic reposition of small intestine was performed. The greater curvature of the stomach was sutured to the transverse mesocolon to prevent recurrence of hernia. DISCUSSION: Previous surgery, low body mass index (BMI), absence of adhesions may predispose the lesser omental hernia. Herniating of intestines through the large openings may occur without presence of acute obstruction or gangrene. CT is helpful in making a correct diagnosis. CONCLUSION: When evaluating the patient with abdominal pain, internal hernia should be considered. CT modalities may aid in the detection of these rare hernias and ensure timely treatment. Perioperative inspection and repair of the hepatogastric ligament may help to prevent lesser omental hernias

Internal Hernias in Acute Abdomen: Review of Literature and Report of four Cases

Internal hernias are very rare in clinical practice and surgeons often disregard internal hernias in spectrum of differential diagnosis in acute abomen. Reaching the diagnosis before internal hernia causes an acute abdomen, is difficult despite modern diagnostic tools, mostly because of wide range of symptoms and variable time of their occurrence. Furthermore, the lag in diagnosis may prove dangerous as they can cause acute bowel or intestinal obstruction. In such cases high mortality has been recorded. In fact, emergency exploratory surgery seems to be of high importance because timing directly influences the outcome. Herein we present four cases with developed acute abdomen due to internal hernia, treatments provided and their outcome along with review of literature

Internal Hernias in Acute Abdomen: Review of Literature and Report of four Cases

Internal hernias are very rare in clinical practice and surgeons often disregard internal hernias in spectrum of differential diagnosis in acute abomen. Reaching the diagnosis before internal hernia causes an acute abdomen, is difficult despite modern diagnostic tools, mostly because of wide range of symptoms and variable time of their occurrence. Furthermore, the lag in diagnosis may prove dangerous as they can cause acute bowel or intestinal obstruction. In such cases high mortality has been recorded. In fact, emergency exploratory surgery seems to be of high importance because timing directly influences the outcome. Herein we present four cases with developed acute abdomen due to internal hernia, treatments provided and their outcome along with review of literature

An unusual case in which a perforated Meckel's diverticulum became trapped in a pericecal hernia: A rare complication of Meckel's diverticulum

AbstractAn 11-year-old boy had previously been diagnosed with repeated Meckel's diverticulitis at another hospital. Emergency laparoscopy was performed under general anesthesia, and an inflammatory mass was seen in the ileocecal region of the mesentery. However, no Meckel's diverticulum (MD) was observed, and so the patient was diagnosed with lymphadenitis. Three days after the operation, he developed anemia and gastrointestinal bleeding of unknown origin. Thus, he was transferred to our hospital for further investigation and to have his gastrointestinal bleeding treated. Based on imaging scans obtained at the previous hospital, a paraduodenal hernia was suspected, but no paraduodenal hernia was detected during emergency surgery, despite the fact that the full length of the normal small intestine could be traced. However, an inflammatory mass was observed, and the ileum appeared to be incarcerated in a pericecal hernia. We could not identify which portion of the intestine had become entrapped or reduce the hernia due to adhesion. The inflammatory mass was removed by ileocecal resection, and a pathological examination revealed that the entrapped portion of the intestine was an MD that had branched off from the small intestine immediately proximal to the ileocecal valve. The MD had perforated in the hernia sac, which had caused the patient's bleeding

Clinical study on Small Intestine Obstruction on Severity Indicators, Etiology, Surgical Outcome

INTRODUCTION SMALL INTESTINAL OBSTRUCTION is one of the common acute emergencies 12 to 16 % in surgical pratice,early recogition and prompt intervention can prevent irreversible ischemia and therby decrease the mortality and long term morbidy 80% of small intestinal obstruction are due to benign cause. Common cause: Adhesion( previous surgery,intra abdominal surgery) Strangulated hernia Tuberculosis Crohn”s disease Mesenteric ischemia Gall stones Bezoar Paralytic lleus AIMS AND OBJECTIVES -To study the incidence and various etiology of small intestinal obstruction -To study the various modes of presentation,importance of early diagnosis and management -To study The role of imaging studies in determining the site and etiology -To study the mortality rate and morbidity ratein acue small intestinal obstruction METHODS: 1 years prospective study conducted in Govt Stanley Medical College Chennai -1 Totally 60 patients were subjected. Each intestinal obstruction patient was evaluated with specific severity indicators, scored and then analysed. RESULTS: The commonest cause of intestinal obstruction in adults in this study series was adhesions in 38.33% cases. Other causes were mesenteric ischaemia, i.e. 4 (6.67%), Koch’s abdomen, i.e. 10(16.67%),Inguinal hernia 5(8.33%),Paralytic ileus 5(8.33%) . Resection anastomosis was most commonly performed procedure in 20 % cases, followed by adhesiolysis in 11.67% patients. 41.67% patients having a score less than 3 were managed Conservatively. CONCLUSION: The evaluation of patients emphasis not only to confirm the diagnosis but also to determine the need for and timing of surgery. Certain severity indicators and scoring systems can help to optimize this timing of surgery and prevent mortality

Imaging the postoperative patient: long-term complications of gastrointestinal surgery

The objectives of this review are (1) to become acquainted with the long-term complications of surgery of the gastrointestinal tract, and (2) to appreciate the appropriate use of imaging in the assessment of long-term complications

Volume 02, issue 2

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1044/thumbnail.jp

Case study of 100 cases of intestinal obstruction

INTRODUCTION: Intestinal obstruction is a common cause of acute abdomen handled by surgeons. Obstruction of inguinal hernias and adhesive obstructions make up a large number of these cases. The clinical presentation varies depending on the type, site, duration etc. Timely evaluation, diagnosis and management plays an important role in disease outcome. This study deals with epidemiology, etiology, clinical features, morbidity and mortality. AIM OF STUDY: 1. To study various causes of intestinal obstruction. 2. To study various presentations of the cases. 3. To study epidemiology of cases. 4. To study various surgical procedures and its outcome. 5. To study factors affecting morbidity and mortality. METHODOLOGY: The materials for the clinical study of intestinal obstruction were collected from cases admitted to various surgical wards of Tirunelveli medical college hospital, during the period from February 2011 to October 2012,hundred cases of intestinal obstruction have been studied. Patients belonged to the age groups ranging from 12 years to 88 years, paediatric age group is excluded from this study. The criteria for selection of cases was based on clinical history, physical findings, radiological and haematological investigations. Patients who were having sub acute intestinal obstruction treated conservatively,patients with a dynamic obstruction and paediatric patients were excluded from the study, and only those cases of acute intestinal obstruction which were managed surgically were studied to establish the aetiology of intestinal obstruction with an aim to know the mode of presentation, physical findings, radiological and haematological findings, operative findings and outcome of acute intestinal obstruction. After the admission of the patient, clinical data were recorded as per Proforma. The diagnosis mainly based on clinical examination and often supported by haematological and radiological examinations. Inclusion criteria: 1. All cases > 12 years age, 2. Both males and females, 3. Small bowel and large bowel obstruction, 4. Cases of acute intestinal obstruction. Exclusion criteria: 1. All cases < 12 years age, 2. Adynamicintestinalobstruction, 3. Sub acute cases. CONCLUSION: Acute intestinal obstruction remains an important surgical emergency in the surgical field Success in the treatment of acute intestinal obstruction depends largely upon early diagnosis skillful management and treating the pathological effects of the obstruction just as much as the cause itself. Erect abdomen X-ray is valuable investigation in the diagnosis of acute intestinal obstruction. 1. The study showed that inguinal hernias are the most common cause of intestinal obstruction. 2. Males were predominantly affected. 3. Age group between 41 – 70 years was the most commonly affected. 4. Patients taking mixed diet was predominantly affected. 5. Most common symptom was vomiting. 6. Most common sign was tachycardia. 7. Mortality was found to be highest with colonic obstruction due to growth. 8. Total number of Anastamotic leak and Wound infection were more in males, though a disproportionately higher incidence occurred in women inspite of their lower numbers. 9. Most common postoperative complication was wound infection. 10. Resection and anastomosis as well as release and herniorrhaphy were the most commonly done surgical procedures

Management of Intestinal Obstruction

Objective: Intestinal obstruction is a blockage of the intestinal content through bowel. The block must be complete and permanent. Obstruction may be mechanical, simple or strangulated, and paralytic. The purpose of this chapter is to clarify, also evaluating our surgical experience, the steps to diagnose and the ways to treat intestinal obstructions

A study of intestinal obstruction in Tirunelveli Medical College, Tirunelveli

INTRODUCTION: Intestinal obstruction is one of the most common problems faced by the general surgeons. Intestinal obstruction was observed and treated by Hippocrates. The earliest recorded observation for intestinal obstruction was performed by Praxagoras (350 B.C.) who created an entercutaneous fistula to relieve the obstruction. However non-operative treatment has remained the general rule, including reduction of hernias, opium for pain, orally administered mercury or lead shot in an attempt to open up the occluded bowel, electrical stimulation & gastric lavage. AIMS OF THE STUDY: 1. To study the incidence of Intestinal obstruction due to mechanical causes in the cases admitted in Tirunelveli Medical College Hospital during the period of July 2003 to January 2006. 2. To study the relative incidence of the various causes of intestinal obstruction. 3. To find out various etiological factors involved. 4. To note the clinical presentations of various types of intestinal obstruction. 5. To study the lines of management adopted with special emphasis on surgical technique employed. 6. To study the prognosis, morbidity and mortality of the various causes of intestinal obstruction. MATERIALS AND METHODS: a) Cases admitted in the Department of Surgery, Tirunelveli Medical College Hospital, between July 2003 to January 2006 forms the materials of this study. b) Case sheets of above mentioned cases and their investigations report also forms the materials of this study. c) Clinical examinations, biochemical, radiological and other investigations, observations during surgery of above cases and their follow up are methods used in this study. “Most of the life’s problems are better understood in retrospect than in prospect to which understanding the intestinal obstruction is no exception. All patients in whom a diagnosis of Intestinal Obstruction was established on admission and confirmed during operation between July 2003 to Jan 2006 were included in this study. Patients admitted with the diagnosis of Intestinal Obstruction but went against medical advice without any operative intervention and paediatric group were excluded. A total of 123 patients satisfied this criteria. The diagnosis was established by the admitting surgeon, based on clinical picture and supported by radiological evidence (ultrasonogram, plain abdominal radiograph together with contrast studies if indicated) and confirmed when appropriate at operation. Surgery was defined as urgent (less than 6 hrs between admission and operation), and delayed (at a later time during the same hospital admission). Operative details included the cause of obstruction, presence or absence of strangulation and nature of operation performed. Mortality was defined as death following surgery while post operative morbidity was defined in terms of the duration of hospital stay and associated complications following surgery. SUMMARY AND CONCLUSION: This study mainly dealt with those forms of intestinal obstruction, which were managed surgically excluding paediatric cases. 123 cases were operated during this study. Adhesions and bands accounted for 29.3% of cases in this series. Most of them were postoperative. Rough handing of bowel, failure to reperitonealise raw areas and use of too tight sutures were found to be some of the aetiological factors. Groin hernias accounted for 28.5% of this series. The constricting agent in the inguinal hernia is external inguinal ring in most of our cases. Volvulus was responsible for 13.8% of cases. Surgical treatment preferably one stage resection is recommended. Chance of recurrence is high in case of conservative treatment and sigmoidopexy. Volvulus was more common in Muslims and that too at the end of fasting season. Most of the patients were elderly males, and were habitually constipated. Intussusception formed 3.3% of our cases. This is more common in paediatric age group. In adults the main aetiological factors are submucous polyps, Meckel’s diverticulum, and inflammation. Early intervention and appropriate surgical correction is the treatment of choice. Plication of the terminal ileum to the ascending colon combined with caecopexy is a useful method to prevent recurrence. However in adults all cases go for resection and anastomosis of involved segments as appropriate treatment. Tumours of the large and small bowel accounted for 13.8% of our cases. In most of these cases there were some symptoms predating the onset of the present complaints. Surgical treatment with primary resection and end-to-end anastomosis is ideal. But some cases will be too much advanced for curative procedure. We had 7 cases of ileocaecal tuberculosis and one case was treated by segmental resection and end-to-end anastomosis. Ileocaecal tuberculosis without intestinal obstruction doesn’t require surgical treatment. Only medical management with anti-tuberculosis drugs gives satisfactory results. Dehydration was there in almost all cases of intestinal obstruction and was severe with small bowel obstruction. Serum electrolyte study revealed low sodium, and potassium levels in proximal small bowel obstruction and low sodium with low normal potassium levels in the distal small gut obstruction. There was not much of electrolyte imbalance in cases with large bowel obstruction. The mortality and morbidity rate is influenced by the time factor, viability of the bowel, comorbid illness and age of the patient. In old patients with gangrenous bowel the mortality rate is high. Primary Resection and anastomosis of the bowel is the mainstay of treatment in all cases of gangrenous bowel and resectable growth. The recent advances in surgery, the modern surgical techniques aseptic and antiseptic measures, the recent advance in anaethesiology, the improvement made and enthusiasm shown by the allied departments like Radiology, Blood Bank and Bio-chemistry have definitely made the patients with intestinal obstruction safer for emergency surgery. The mortality and morbidity are very much reduced by the adequate correction of electrolyte imbalance and the replacement of lost blood and by the proper surgical techniques employed. The observer was present in 55 cases through out the initial evaluation, resuscitation and surgical procedure, Information of the rest of 68 cases were obtained from case records. 1. Identification particulars viz, Name, Age, Sex, IP No etc. 2. Clinical features and abdominal findings. 3. Radiological findings and contrast studies. 4. Time of surgery after admission. 5. Operative findings. 6. Procedure done. 7. Postoperative complications. 8. Follow up. Patients were followed up till the time of their discharge from hospital or two years following surgery