Simultaneous small and large bowel obstruction as a consequence of internal hernia: A case report

Malek A Al- Omari,Mohammad A Al-Doud

doi:10.1016/j.ijscr.2019.02.023

Malek A Al- Omari, Mohammad A Al-Doud

Open Access

https://doi.org/10.1016/j.ijscr.2019.02.023

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Abstract

IntroductionIntestinal obstruction ascribed to internal hernia is quite rare, especially in adults. There are no differentiating features in the presentation of intestinal obstruction due to internal hernia as compared to other causes. Delay in the diagnosis of this condition carries a considerable risk especially in a virgin abdomen. We report a rare case of internal hernia which presented as acute small and large bowel obstruction. Presented caseWe report a 47- year- old male with generalized abdominal pain associated with vomiting and obstipation. The patient was in hypovolemic shock that only had a transient response to resuscitation. CT scans of the abdomen with contrast was done and showed both large and small bowel obstruction. Exploration laparotomy was done and revealed a concurrent nonviable portion of ileum and twisted sigmoid colon (volvulus) which protruded through a congenital transmesentric defect. Resection was mandatory, and repair of the defect was done. DiscussionIncidence of internal hernia generally does not exceed 1%. The diagnosis of congenital internal hernia relies on absence history of trauma, inflammatory process and abdominal surgery. Protrusion of simultaneous small and large bowels together through transmesenteric congenital gate is uncommon. ConclusionWhether the patient presenting with intestinal obstruction has a history of undergoing previous surgeries (for any reason) or not, the diagnosis of internal hernia must be kept in mind. Coexisting involvement of both small and large bowels that need resection poses the question of the need for restoration of bowel continuity with either colostomy or ileostomy.

Highlights

Intestinal obstruction ascribed to internal hernia is quite rare, especially in adults
Internal hernia is defined as protrusion of intestines through a congenital or acquired an intra-abdominal defect [1]
We report our experience with an adult male patient who had a congenital trans-mesentric hernia, involving nonviable small and large bowel which both needed resection

Summary

INTRODUCTION

Intestinal obstruction ascribed to internal hernia is quite rare, especially in adults. We report a rare case of internal hernia which presented as acute small and large bowel obstruction. CT scans of the abdomen with contrast was done and showed both large and small bowel obstruction. The diagnosis of congenital internal hernia relies on absence history of trauma, inflammatory process and abdominal surgery. CONCLUSION: Whether the patient presenting with intestinal obstruction has a history of undergoing previous surgeries (for any reason) or not, the diagnosis of internal hernia must be kept in mind. Coexisting involvement of both small and large bowels that need resection poses the question of the need for restoration of bowel continuity with either colostomy or ileostomy

Introduction

Case report

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