Internal Hernias: Diagnosis and Management

Abstract

Introduction: Internal hernias are rare, with an overall incidence of less than 1%. They account for 0.5 to 5.8 % of cases of intestinal obstructions. If left untreated, their overall mortality exceeds 50 % in cases of strangulation. The aim of this work is to report 04 new cases of different types of internal hernias and to review the literature on the circumstances of occurrence, discovery, and therapeutic modalities for internal hernias. Observations: We report four (04) observations concerning different types of internal hernias: (02 peri-cecal internal hernias, one hernia through the Winslow's hiatus, and one supra-vesical internal hernia), all revealed by clinical presentations of acute intestinal obstructions and confirmed by preoperative CT scan. Our patients (03 men and 01 woman) have an average age of 63 years. All 04 cases were operated on urgently, with 03 undergoing laparotomy and 01 undergoing laparoscopy. The procedure performed is the reduction of the hernia (viable strangulated small bowel loops) with closure of the hernial orifice to prevent recurrences. Postoperative courses were uneventful in all four patients. The average length of hospital stay is 02 days. After a follow-up ranging from 02 years to 08 years, no recurrence was observed. Conclusion: Internal hernias are rare and should be considered in cases of acute intestinal obstruction, especially in patients without abdominal surgical history or trauma. Laparotomy remains the most commonly used surgical approach, but laparoscopy is increasingly reported in recent publications.