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Post-operative transmesosigmoid hernia causing small bowel obstruction: a case report.

Farah RH, Fahmi Y, Khaiz D, Elhattabi K, Bensardi F, Lefriyekh R, Berrada S, Fadil A, Ouariti NZ - Pan Afr Med J (2015)

Bottom Line: History, clinical and radiography examination were suggested intestinal obstruction due to postoperative adhesion.The herniated loop was reduced successfully and the defect was approximated with interrupted sutures.The postoperative course was uneventful and the patient is free from symptoms and recurrence.

View Article: PubMed Central - PubMed

Affiliation: Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco.

ABSTRACT
Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Transmesosigmoid hernia is rare type among others mesosigmoid hernia was rarely reported in the literature. We report the case of a 44-year-old male who presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiography examination were suggested intestinal obstruction due to postoperative adhesion. The diagnosis of small bowel obstruction due to internal hernia was confirmed by laparotomy exploration. The herniated loop was reduced successfully and the defect was approximated with interrupted sutures. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This case report highlight difficulty and importance of high index of suspicion considering an internal hernia as a cause of small bowel obstruction in individuals of all age groups with or without a previous history of abdominal surgery.

No MeSH data available.


Related in: MedlinePlus

Abdominal CT scan demonstrating small intestinal dilatation with free air fluid level
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Figure 0001: Abdominal CT scan demonstrating small intestinal dilatation with free air fluid level

Mentions: A 44-year-old man presented acutely with a 1-day history of colicky central abdominal pain, abdominal distension, vomiting and absolute constipation. He had previous history of left segmental colectomy 4 months ago. Physical examination revealed dry mucous membranes and tenderness in the left lower quadrant. Bowel sounds were increased and digital rectal examination empty rectal pouch. Laboratory investigations revealed a leukocytosis of 12400/mm3. Plain abdominal radiography demonstrated two prominent loops of small bowel in the left lower quadrant. Nasogastric tube was inserted and he was resuscitated with intravenous fluids. A computed tomography (CT) scan of abdomen showed small intestinal obstruction caused by post-operative adhesion (Figure 1) with dilated loops of small bowel. Based on his clinical and CT findings a decision was made to perform an exploratory laparotomy. At laparotomy, a mechanical small bowel obstruction due to an incarcerated internal hernia was found. A loop of ileum had herniated through a post-operative defect in the mesosigmoid (Figure 2). The herniated loop was reduced successfully and the defect was approximated with interrupted 3/ 0 poliglecaprone sutures. The strangulated portion of small bowel was found to be viable. In this case the hernial orifice measured 4.5 cm and consisted of two leaves of the sigmoid mesentery. No hernial sac was present.


Post-operative transmesosigmoid hernia causing small bowel obstruction: a case report.

Farah RH, Fahmi Y, Khaiz D, Elhattabi K, Bensardi F, Lefriyekh R, Berrada S, Fadil A, Ouariti NZ - Pan Afr Med J (2015)

Abdominal CT scan demonstrating small intestinal dilatation with free air fluid level
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4491479&req=5

Figure 0001: Abdominal CT scan demonstrating small intestinal dilatation with free air fluid level
Mentions: A 44-year-old man presented acutely with a 1-day history of colicky central abdominal pain, abdominal distension, vomiting and absolute constipation. He had previous history of left segmental colectomy 4 months ago. Physical examination revealed dry mucous membranes and tenderness in the left lower quadrant. Bowel sounds were increased and digital rectal examination empty rectal pouch. Laboratory investigations revealed a leukocytosis of 12400/mm3. Plain abdominal radiography demonstrated two prominent loops of small bowel in the left lower quadrant. Nasogastric tube was inserted and he was resuscitated with intravenous fluids. A computed tomography (CT) scan of abdomen showed small intestinal obstruction caused by post-operative adhesion (Figure 1) with dilated loops of small bowel. Based on his clinical and CT findings a decision was made to perform an exploratory laparotomy. At laparotomy, a mechanical small bowel obstruction due to an incarcerated internal hernia was found. A loop of ileum had herniated through a post-operative defect in the mesosigmoid (Figure 2). The herniated loop was reduced successfully and the defect was approximated with interrupted 3/ 0 poliglecaprone sutures. The strangulated portion of small bowel was found to be viable. In this case the hernial orifice measured 4.5 cm and consisted of two leaves of the sigmoid mesentery. No hernial sac was present.

Bottom Line: History, clinical and radiography examination were suggested intestinal obstruction due to postoperative adhesion.The herniated loop was reduced successfully and the defect was approximated with interrupted sutures.The postoperative course was uneventful and the patient is free from symptoms and recurrence.

View Article: PubMed Central - PubMed

Affiliation: Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco.

ABSTRACT
Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Transmesosigmoid hernia is rare type among others mesosigmoid hernia was rarely reported in the literature. We report the case of a 44-year-old male who presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiography examination were suggested intestinal obstruction due to postoperative adhesion. The diagnosis of small bowel obstruction due to internal hernia was confirmed by laparotomy exploration. The herniated loop was reduced successfully and the defect was approximated with interrupted sutures. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This case report highlight difficulty and importance of high index of suspicion considering an internal hernia as a cause of small bowel obstruction in individuals of all age groups with or without a previous history of abdominal surgery.

No MeSH data available.


Related in: MedlinePlus