Internal Hernia Research Articles (Page 1)

Bariatric surgery has become the cornerstone in the management of severe obesity, offering significant and sustained weight reduction alongside improvement or resolution of obesity-related comorbidities. This review provides a comprehensive analysis of the different bariatric procedures Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric banding (AGB), and biliopancreatic diversion (BPD) and compares their efficacy, complications, ethical implications, and global trends. Early and late complications remain procedure-dependent, ranging from internal hernias and gallstone formation to nutritional deficiencies and psychological adjustments. Comparative studies demonstrate that RYGB and SG achieve superior long-term weight reduction compared to AGB and non-surgical interventions. Patient selection criteria, ethical considerations, and economic impact remain central to optimizing outcomes and ensuring equitable access to treatment. The role of multidisciplinary teams is vital for ensuring long-term success, providing holistic care through preoperative assessment, psychological counseling, and nutritional follow-up. Advances in surgical technology, patient-centered care models, and policy frameworks continue to shape the field. Future research should focus on personalized surgical approaches, integration of digital monitoring, and equitable policy development to enhance the safety, accessibility, and sustainability of bariatric surgery worldwide. Keywords: Bariatric surgery, Obesity management, surgical outcomes, Multidisciplinary care, Ethical and policy considerations.

Techniques such as retroperitoneal graft placement have further enhanced the ability to replicate the physiology of the “native” pancreas. In our center, from January 2000, duodenojejunostomy (DJ) was the standard technique for exocrine drainage (n = 337). Herein, we report a series of 188 pancreas transplantations performed between May 2016 to July 2025, using a fully retrocolic graft position, systemic venous drainage and enteric drainage via duodenoduodenostomy. The primary endpoint was the assessment of intestinal events and their impact on graft and patient survival. A total of 14 patients (7.4%) experienced complications, including paralytic ileus (n = 2), intestinal obstruction (n = 4), duodenal dehiscence following pancreas transplantectomy (n = 1), anastomotic dehiscence (n = 5), and anastomotic bleeding (n = 2). Of these, 11 cases required relaparotomy for adhesiolysis (n = 2), internal hernia repair (n = 1), Hartmann’s procedure (n = 1), transplantectomy (n = 2), primary leak closure (n = 3), and hemostasis with duodenal re-anastomosis (n = 2). After a median follow-up of 42.8 months [IQR 21.8–71.1], graft survival at 1 and 5 years was 87% and 83.4%, respectively (P = 0.688 vs. DJ group), while patient survival was 100% and 98.2% (P = 0.031 vs. DJ group). Duodenoduodenostomy proved to be a feasible and effective technique, offering competitive outcomes in terms of graft and patient survival.

Introduction: Internal hernias are a rare cause of acute intestinal obstruction, accounting for only 0.5–1% of all cases. Diagnosis relies mainly on computed tomography (CT), and treatment is surgical. Case presentation: We report the case of a 48-year-old woman with no prior medical history, admitted for acute epigastric pain with vomiting. Abdominal CT revealed ectopic small-bowel distension in the right subhepatic region, consistent with an internal hernia. Exploratory laparoscopy confirmed a subhepatic internal hernia through a peritoneal defect forming a ring between the right hepatic lobe, gallbladder, transverse colon, and cholecysto-duodeno-colic ligament. A 20-cm necrotic ileal segment was resected with primary anastomosis. Postoperative recovery was uneventful. Conclusion: Subhepatic internal hernias are extremely rare. CT imaging remains essential for preoperative diagnosis, while laparoscopy represents the preferred surgical approach.

Congenital internal hernias causing small bowel obstruction are extremely rare in adults, with only approximately 28 cases reported in the literature. The condition carries a high mortality rate-up to 50% even with treatment, and nearly 100% without intervention. Diagnosis is particularly challenging due to the nonspecific nature of symptoms and often inconclusive imaging findings. We present a patient diagnosed with a trans mesenteric hernia resulting from a congenital defect. The patient failed conservative management, which included bowel rest, nasogastric tube placement, and monitoring with KUB X-rays. A diagnostic laparoscopy was performed and subsequently converted to a laparotomy. Intraoperative findings revealed a 6 cm defect in the mesentery with approximately 60 cm of small bowel herniating through, showing signs of early ischemia. Bowel viability was restored following reduction, and the mesenteric defect was closed. Congenital mesenteric defects, though rare, are an important consideration in the differential diagnosis of de novo small bowel obstruction, particularly in adults with a virgin abdomen and no history of prior abdominal surgery. Early recognition and prompt surgical intervention are essential, as timely management can significantly reduce the risk of morbidity and mortality.

Rationale:The incidence of intra-abdominal hernia is very low, ranging from 0.2% to 0.9% in autopsy cases and 0.5% to 4.1% in cases of intestinal obstruction. Broad ligament hernia accounts for 4% to 7% of all cases of intra-abdominal hernias.Patient concerns:A 39-year-old transient woman presented with persistent lower abdominal pain for 5 hours without any obvious cause, accompanied by anal distension and no other unusual symptoms. Initially, the patient did not undergo any intervention.Diagnoses:The computed tomography showed that the left adnexal area had a cystic low-density shadow, gas density shadow, and a close intestinal relationship, suggesting that the thickening and tortuous intestinal tube may be an adnexal source of cystic foci to be drained. Laparoscopy revealed an internal hernia caused by a broad ligament defect on the left side.Interventions:The patient was initially treated non-operatively, symptoms worsened and he was given a laparoscopic exploration with intraoperative repositioning of the bowel and repair of the defect.Outcomes:The patient started to eat on the first day after the operation when the gastrointestinal function was restored and was discharged from the hospital 3 days after the operation. In the follow-up examinations in January and June after the operation, the patient had no abdominal pain, abdominal distension, or discomfort and had normal bowel movement.Lessons:Broad ligament hernias are rare with no specific manifestations. Abdominal computer tomography is helpful for the diagnosis of a broad ligament hernia, and it should be completed in time for the timely detection of intestinal obstruction that cannot be clearly identified. Early diagnosis of hernia can be accomplished through laparoscopy to reset the hernia and repair the defect.

Clinical application of modified lateral-perineal approach for obturator ring injuries.

Introduction. In recent years, there has been a significant rise in the number of pediatric cases involving multiple magnet ingestion, resulting in increased incidence and morbidity of injuries. When a metal object and magnet are ingested, either single or multiple, they can cause serious complications such as intestinal obstruction, ischemia, necrosis, fistula, perforation, and even death. This study aims to detail the complications and treatment approaches associated with magnet ingestion in children. Materials and Methods. In our study, we conducted a retrospective analysis of all cases involving the ingestion of a magnet along with a second metal object at two training and research hospitals in our province, which admit pediatric patients, between the years of 2013 and 2023. Results. A total of 42 patients had a history of magnet ingestion, with the number of ingested magnets ranging from 1 to 41. The median magnet size was 11 mm (range: 5.5-17.5 mm) and the median time to presentation was 24 hours (range: 3-48 hours). Thirteen patients (30.9%) required either endoscopic or surgical intervention to extract the magnets or address complications. Endoscopy was performed on eight patients, while surgical intervention was required for five patients. Among those who underwent surgery, four experienced complications, including intestinal perforation, ileoileal fistula, and internal herniation. Notably, no fatalities occurred following intervention. There was no statistically significant difference in age or magnet size between the interventional and non-interventional groups. However, the length of hospital stay was significantly longer in the interventional group compared to the non-interventional group (P

Structured assessment of abdominal computed tomography (CT)-scans is increasingly used to identify signs of internal herniation after Roux-en-Y gastric bypass (RYGB), aiding in the decision-making process to perform a diagnostic laparoscopy (DLS). This study aimed to develop a prediction score based on structured assessment of CT-signs for internal herniation. Patients presenting with abdominal pain after RYGB, who underwent a CT-scan for suspicion of internal herniation and subsequently DLS, were included. CT-scans were reassessed for presence of ten CT-signs for internal herniation by two radiologists and two registrars. Diagnostic accuracy for detection of internal herniation for each sign and an overall suspicion score were calculated and compared with the original CT-reports. Interobserver agreement was measured using Fleiss' kappa. A prediction score was developed based on variables identified by multivariable logistic regression. With DLS 44 internal herniations (114 CT-scans, 92 patients) were identified. Structured assessment improved diagnostic accuracy compared to the original CT-report (AUC of 0.69 to 0.79, p = 0.03), and the positive (67% to 81%) and negative predictive value (75% to 82%). The three-sign prediction score (venous congestion, swirl sign, right-sided anastomosis) resulted in improved diagnostic accuracy compared to the original CT-report (AUC of 0.69 to 0.79, p = 0.038). Interobserver agreement of these signs was adequate between all readers (K = 0.56-0.75). Structured assessment of CT-scans improves diagnostic accuracy for internal herniation after RYGB. Our three-sign prediction-model offers a simplified, reproducible alternative to extensive assessment, without compromising the improved diagnostic effectiveness.

The most frequent long-term complications following intestinal bypass procedures that require surgical treatment are internal hernia and treatment-refractory anastomotic ulcer. The risk of internal hernia after Roux-en‑Y gastric bypass ranges from 5-15% and, although it can be reduced by meticulous intraoperative closure of mesenteric defects, it cannot be entirely prevented. Internal hernia usually becomes clinically apparent after significant postoperative weight loss, typically within months to a few years and should ideally be managed by laparoscopic repositioning of the small bowel and closure of the mesenteric defect. Treatment-refractory anastomotic ulcer is most frequently associated with risk factors such as persistent nicotine use during aHelicobacter pylori infection and discontinuation of proton pump inhibitor (PPI) treatment. In addition, anatomical features such as alarge gastric pouch or acircumferentially fashioned anastomosis predispose to ulcer formation. The reported incidence after gastric bypass varies considerably and ranges between 1% and 53%. Standard management consists of rigorous elimination of risk factors combined with PPI treatment. In cases of chronicity or (covered) perforation, surgical revision with resection and reconstruction of the anastomosis is required. Choledocholithiasis secondary to cholecystolithiasis represents aparticular interdisciplinary challenge due to limited endoscopic access to the papilla of Vater. Established treatment options include endoscopic balloon enteroscopy, retrograde cholangiography via the gastric remnant, which is opened laparoscopically assisted, revision of the bile duct performed during laparoscopic cholecystectomy or percutaneous transhepatic cholangial drainage (PTCD). Management of these long-term complications should preferentially be carried out in certified centers for metabolic and bariatric surgery with appropriate specific expertise.

Internal hernias are a rare cause of small-bowel obstruction (SBO), particularly in patients without prior abdominal surgery. This case report describes a 70-year-old male presenting with acute intestinal obstruction in a virgin abdomen. Initial imaging suggested SBO but failed to identify a clear transition point. Diagnostic laparoscopy revealed a rare internal hernia caused by a ring formed by the inflamed epiploic appendages of the sigmoid colon. The entrapped bowel was successfully released, and histopathological examination confirmed epiploic appendagitis. This case highlights the diagnostic challenges of SBO due to internal hernias and underscores the importance of surgical exploration in unclear cases. Early identification and intervention are crucial to prevent complications such as bowel ischaemia. This report contributes to the limited literature on epiploic appendage-induced internal hernias, emphasising the need for multidisciplinary collaboration in managing rare abdominal pathologies.

Petersen’s hernia is a rare but potentially life-threatening complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). Its clinical presentation is often nonspecific, and radiological findings may be subtle, contributing to diagnostic delays. This retrospective study included all patients diagnosed and surgically treated for Petersen’s hernia at Unidade Local de Saúde de Braga, EPE, between January 2023 and June 2025. A total of six patients (three men, three women) were identified, with a mean age of 44 years (range: 31-64 years). All patients had previously undergone LRYGB. The interval between primary surgery and hernia presentation ranged from 20 days to 12 years. Abdominal pain was a universal symptom, frequently accompanied by nausea or vomiting (67%). Computed tomography (CT) suggested internal hernia in five cases (83%), with the swirl sign being the most commonly observed feature. Surgical exploration was performed via laparoscopy in four cases and laparotomy in two. Petersen’s hernia was confirmed in all patients, with no need for bowel resection. All defects were closed using double-layer, non-absorbable barbed sutures. The mean length of hospital stay was 4.3 days (range: 2-6 days), and no postoperative complications, readmissions, or symptom recurrence were observed during follow-up. Despite advances in imaging, Petersen’s hernia remains a diagnostic challenge that may present years after bariatric surgery. High clinical suspicion and prompt surgical exploration are essential. Routine closure of mesenteric defects and management by bariatric-trained surgeons appear to be critical in minimizing morbidity and improving outcomes.

Roux-en-Y gastric bypass (RYGB) is a common and effective treatment of obesity. The development of an internal hernia after RYGB is the result of herniation of the small bowel through mesenteric defects created at the time of surgery. This can lead to further complications including recurrent abdominal pain and small bowel obstruction. In the most dire cases, closed-loop obstruction and/or volvulus can occur and lead to bowel ischemia and necrosis. Given the potentially severe complications of internal hernias after RYGB, it is incumbent on the radiologist to assess for them in all patients undergoing abdominal CT who have undergone RYGB, especially those presenting with abdominal pain. Detection of an internal hernia after RYGB at CT can be challenging. The authors discuss the postoperative anatomy after RYGB and the manner in which it can lead to internal hernias, the incidence of and risk factors for internal hernias, and the various signs at CT that can signal the presence of an internal hernia after RYGB. ©RSNA, 2025 Supplemental material is available for this article.

Internal hernia following No.253 lymph node dissection in colon cancer: A case report

ABSTRACTObturator hernia is a rare internal hernia causing significant mortality and morbidity in elderly age groups. Diagnosis of obturator hernia is challenging because of vague atypical presentations. This case report describes a woman in her late 80s who presented with colicky right lower abdominal pain, abdominal distension, and obstipation, diagnosed with a right obturator hernia, computed tomography (CT) scan. An elderly female presented with chief complaints of right lower abdominal pain and abdominal distension. On examination, the abdomen was distended with generalized tenderness and rebound tenderness. CECT abdomen and pelvis showed dilated small bowel loops with a transition point caused by herniation through the right obturator foramen. Emergency laparotomy revealed a right strangulated obturator hernia. Resection of the gangrenous ileal segment with ileo‐ileal anastomosis and primary closure of the defect was done. Obturator hernia occurs through the obturator canal, which is mostly seen in elderly females. Obturator hernia usually presents as partial bowel obstruction because of a high frequency (41%–100%) of Richter's herniation of the small bowel into the obturator canal. Diagnosis can be delayed because of its nonspecific clinical presentation. CT scan is the most accurate and sensitive way to diagnose the obturator hernia. Obturator defects can be repaired by various methods including simple suture closure, closure of the obturator with adjacent tissue, and mesh placement during laparotomy. Obturator hernia is a rare abdominal hernia with delayed diagnosis because of vague atypical clinical presentation. Early diagnosis and prompt surgical treatment are essential to reduce morbidity and mortality.

A Rare Encounter: Small Bowel Obstruction Secondary to Transomental Internal Hernia

BackgroundMesenteric hiatal hernia represents a significant complication following gastrointestinal surgery, and the closure of mesenteric defects has been shown to mitigate the risk of such hernias. SSJIBL, a surgical technique that has gained prominence in recent years, is widely acknowledged for its efficacy in glucose reduction and its association with fewer complications. Nevertheless, there remains a gap in the literature regarding the optimal suture choice for closing mesenteric defects, as no definitive studies or reports have addressed this specific issue to date. So we wanted to know what sutures we could use to more safely close the mesenteric defect.Materials and methods36 New Zealand rabbits were divided into three groups, NC, Absorbable suture and Non-absorbable suture. Group NC was not operated, group Absorbable suture close the mesenteric defect with absorbable suture, and group Non-absorbable suture close the mesenteric defect with non-absorbable suture; the rabbits were weighed and measured monthly, and after three months, the rabbits were observed to see if there was any internal hernia and to detect the tethered lacunae tension.ResultsAccording to the results of the experiment, both absorbable suture and non-absorbable suture can induce infiltration of inflammatory cells and enhance adhesion strength relative to the NC group.ConclusionBoth absorbable and non-absorbable sutures are safe and reliable.

Introduction: The "disease" called "Intestinal Obstruction" is a sign that evolves into a syndrome or even a diagnosis, when in fact it is a consequence of another pathology/etiological diagnosis. Objective: experience of the Surgery and Colon and Rectal Surgery services in patients with recurrent bowel obstruction. Method: retrospective, longitudinal, observational and descriptive study. The records and files of patients treated surgically for recurrent, multicenter intestinal obstruction in three hospitals were reviewed. Results: 183 patients with recurrent intestinal occlusion, of these 19 were included, 16 women (84.21 %) / 3 men (15.79 %), mean of 46 years, range 32 to 71 years. Childs' intestinal plication was modified by the Mexican surgeon Dr. Roberto Blanco Benavidez, which was successful and without recurrence of intestinal obstruction. Discussion: Many patients with intestinal obstruction are secondary to adhesions due to surgical history being 60%, and being the cause of internal hernia, intestinal torsion, stenosis, intestinal ischemia, necrosis, perforation and peritonitis; it is then to carry out an exploratory laparotomy that fortuitously the surgical lysis of the adhesions, with an imminent recurrence of obstruction. Conclusion: Surgery today is the definitive resolving hope of recurrent intestinal obstruction, and Blanco's intestinal plication is to date the only certain, simple, safe and promising option, which meets the objective, not of avoiding adhesion but of forming them in an orderly and functional way, preventing the recurrence of intestinal obstruction.

Background: Internal hernias are rare and constitute only a small fraction of bowel obstruction cases. Herniation through the broad ligament of the uterus, known as Allen-Masters syndrome, is an exceptionally rare cause of small bowel obstruction. Case Report: We present the case of a 56-years-old woman with clinical signs indicative of mechanical bowel obstruction. During diagnostic laparoscopy, a segment of the small bowel was found entrapped within the broad ligament (ligamentum latum uteri). The entrapped bowel loop was released, and the ligament defect was sutured. Conclusion: A defect in the ligamentum latum uteri, as seen in Allen-Masters syndrome, is a rare and often incidental finding in female patients presenting with ileus. This syndrome may account for nonspecific symptoms such as dyspareunia, dysmenorrhea, and both acute and chronic pelvic pain. Allen-Masters syndrome can be effectively diagnosed and treated through a laparoscopic approach.

Efficacy and safety of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy versus Roux-en-Y gastric bypass in France (SADISLEEVE): results of a randomised, open-label, superiority trial at 2 years of follow-up.

The radiographic diagnosis of internal hernia following Roux-en-Y gastric bypass (RYGB) can be difficult. Here, we sought to improve the detection of internal hernias through the implementation of a structured CT reporting tool. This is a single-institution, retrospective cohort study of RYGB patients presenting to the Emergency Department. In 2023, an educational seminar and a structured CT tool were both implemented to incorporate the signs of internal hernia into CT reads. The tool incorporates the following: Antecolic/retrocolic Roux limb, jejunojejunostomy sidedness, abnormalities of the superior mesenteric vein, presence of mesenteric swirl or mesenteric edema, small bowel obstruction, small bowel clustering, bowel loops located posterior to the Roux limb mesentery, any significant changes in bowel loop configuration from prior CT scans, and a final impression of the presence or absence of internal hernia. A Pre-Intervention period of 1year was used to compare CT scans 1year after the implementation. During the Pre-Intervention period, 139 CT scans were obtained. Five (3.0%) radiographic diagnoses of internal hernia were made, four of which underwent operative reduction. Six internal hernias (3.7%) were missed by CT. All six required surgical reduction, with one experiencing entire small bowel necrosis resulting in resection and small bowel transplantation. During the Post-Intervention period, 49.7% of the 193 CT scans included the structured CT reporting tool. Eight (3.7%) radiographic diagnoses of internal hernia were made, six of which underwent operative reduction. Two diagnoses of internal hernia were missed on CT scan (1.1%). The sensitivity for internal hernia detection in the Pre- and Post-Intervention groups was 40.0 vs. 75.0% (p = 0.14), and the specificity was 99.2 vs. 98.9%, respectively (p = 0.79). Implementing a structured tool for the detection of internal hernias with CT scans may improve the diagnosis rates of internal hernia among those who have undergone RYGB.