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Small Bowel Obstruction Secondary to Interstitial Hernia: Laparoscopic Approach.

Alvarez Gallesio JM, Schlottmann F, Sadava EE - Case Rep Surg (2015)

Bottom Line: We present a case of abdominal bowel obstruction secondary to interstitial hernia on the fifth postoperative day of an open incisional hernia repair.Laparoscopy confirmed the diagnosis and led to an accurate treatment avoiding a new laparotomy.In this case, prompt surgical decision based on clinical and CT scan findings allowed a mini-invasive approach with satisfactory outcome.

View Article: PubMed Central - PubMed

Affiliation: Division of Abdominal Wall Surgery, Department of General Surgery, Hospital Alemán of Buenos Aires, Avenida Pueyrredon 1640, C1118AAT Buenos Aires, Argentina.

ABSTRACT
Interstitial hernias are a rare entity. Most of them are detected incidentally on imaging studies. We present a case of abdominal bowel obstruction secondary to interstitial hernia on the fifth postoperative day of an open incisional hernia repair. Laparoscopy confirmed the diagnosis and led to an accurate treatment avoiding a new laparotomy. In this case, prompt surgical decision based on clinical and CT scan findings allowed a mini-invasive approach with satisfactory outcome.

No MeSH data available.


Related in: MedlinePlus

Uncovered mesh after posterior sheath fixation with absorbable tackers. The defects were measured.
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fig3: Uncovered mesh after posterior sheath fixation with absorbable tackers. The defects were measured.

Mentions: A 49-year-old woman was admitted for a large ventral incisional hernia repair. Medical records showed obesity (BMI: 32 kg/m2), orthotopic liver transplantation for alcoholic cirrhosis (2013) and hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer (2014), and recent consultation for pain secondary to noncomplicated incisional hernia but altering her quality of life. Preoperative assessment for cardiac and pulmonary function was suitable. An open ventral incisional hernia repair was performed through a xyphopubic incision and a polypropylene mesh was used in a sublay fashion. The polypropylene mesh was placed in the plane between posterior rectus muscle sheath and rectus abdominis muscle, as in Rives-Stoppa procedure. She was discharged at the first postoperative day. On the fifth postoperative day she was readmitted for increasing abdominal pain with nausea and vomiting. Computed tomography (CT) scan revealed a defect in the posterior layer of the rectus abdominis muscle sheath, with jejunal loops passing through a gap between the posterior sheath and the mesh, which was fixed to the rectus abdominis muscle (Figure 1). Surgical treatment was decided and laparoscopic approach was performed by the same surgical team. The small bowel loops were visualized between abdominal wall layers (Figure 2). Careful soft traction maneuvers were initiated and executed and after the complete reduction of unharmed intestine we observed two defects in the posterior layer of the rectus sheath, with a diameter of 3 and 4 cm. Interstitial space (between polypropylene mesh and posterior sheath of rectus abdominis muscle) was explored verifying correct mesh fixation. The detached posterior sheath was fixated to the abdominal wall with absorbable tackers, reinforcing the rim of the defects with double crown technique (Figure 3). Finally, the greater omentum was relocated to cover the exposed mesh in order to reduce visceral adhesions. The postoperative course was uneventful and patient was discharged at the second postoperative day. At the six-month follow-up there were no signs of recurrence.


Small Bowel Obstruction Secondary to Interstitial Hernia: Laparoscopic Approach.

Alvarez Gallesio JM, Schlottmann F, Sadava EE - Case Rep Surg (2015)

Uncovered mesh after posterior sheath fixation with absorbable tackers. The defects were measured.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4631879&req=5

fig3: Uncovered mesh after posterior sheath fixation with absorbable tackers. The defects were measured.
Mentions: A 49-year-old woman was admitted for a large ventral incisional hernia repair. Medical records showed obesity (BMI: 32 kg/m2), orthotopic liver transplantation for alcoholic cirrhosis (2013) and hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer (2014), and recent consultation for pain secondary to noncomplicated incisional hernia but altering her quality of life. Preoperative assessment for cardiac and pulmonary function was suitable. An open ventral incisional hernia repair was performed through a xyphopubic incision and a polypropylene mesh was used in a sublay fashion. The polypropylene mesh was placed in the plane between posterior rectus muscle sheath and rectus abdominis muscle, as in Rives-Stoppa procedure. She was discharged at the first postoperative day. On the fifth postoperative day she was readmitted for increasing abdominal pain with nausea and vomiting. Computed tomography (CT) scan revealed a defect in the posterior layer of the rectus abdominis muscle sheath, with jejunal loops passing through a gap between the posterior sheath and the mesh, which was fixed to the rectus abdominis muscle (Figure 1). Surgical treatment was decided and laparoscopic approach was performed by the same surgical team. The small bowel loops were visualized between abdominal wall layers (Figure 2). Careful soft traction maneuvers were initiated and executed and after the complete reduction of unharmed intestine we observed two defects in the posterior layer of the rectus sheath, with a diameter of 3 and 4 cm. Interstitial space (between polypropylene mesh and posterior sheath of rectus abdominis muscle) was explored verifying correct mesh fixation. The detached posterior sheath was fixated to the abdominal wall with absorbable tackers, reinforcing the rim of the defects with double crown technique (Figure 3). Finally, the greater omentum was relocated to cover the exposed mesh in order to reduce visceral adhesions. The postoperative course was uneventful and patient was discharged at the second postoperative day. At the six-month follow-up there were no signs of recurrence.

Bottom Line: We present a case of abdominal bowel obstruction secondary to interstitial hernia on the fifth postoperative day of an open incisional hernia repair.Laparoscopy confirmed the diagnosis and led to an accurate treatment avoiding a new laparotomy.In this case, prompt surgical decision based on clinical and CT scan findings allowed a mini-invasive approach with satisfactory outcome.

View Article: PubMed Central - PubMed

Affiliation: Division of Abdominal Wall Surgery, Department of General Surgery, Hospital Alemán of Buenos Aires, Avenida Pueyrredon 1640, C1118AAT Buenos Aires, Argentina.

ABSTRACT
Interstitial hernias are a rare entity. Most of them are detected incidentally on imaging studies. We present a case of abdominal bowel obstruction secondary to interstitial hernia on the fifth postoperative day of an open incisional hernia repair. Laparoscopy confirmed the diagnosis and led to an accurate treatment avoiding a new laparotomy. In this case, prompt surgical decision based on clinical and CT scan findings allowed a mini-invasive approach with satisfactory outcome.

No MeSH data available.


Related in: MedlinePlus