Transmesenteric Hernia Research Articles

Don't be thrown for a loop: a review of internal hernias for the abdominal imager.

Internal hernias are herniations of abdominal viscera, usually small bowel, through congenital or acquired openings of the peritoneum or mesentery. Congenital hernias may involve anatomic fossae such as the epiploic foramen as well as those related to abnormal peritoneal or mesenteric defects; these include left and right paraduodenal, transomental, transmesenteric, pericecal and broad ligament hernias. Acquired hernias are due to defects in the mesentery or peritoneum, usually resulting from prior surgeries, and include those associated with Roux-en-Y surgery as well as colorectal cancer resections. Internal hernias account for 5.8% of small obstructions. Obstructed internal hernias are considered surgical emergencies due to the high risk of bowel strangulation. This review summarizes the various types of congenital and acquired internal hernias, their relevant anatomy, embryology, associated surgical history and imaging appearance. We will also discuss a location-based approach to identifying internal hernias on CT, as well as complications and relevant signs, of which abdominal imagers should be vigilant.

A rare case of Pouch of Douglas hernia- Atypical presentation in a postnatal mother

Background: Internal hernias are quite rare which constitutes right and left paraduodenal, trans-mesenteric hernia and pelvic hernias. Case presentation: 23 year old female postnatal mother delivered 4 months back, IUCD was inserted post delivery now presented with C/O greenish discharge PV and vaginal fullness. Ultrasound showed few dilated small bowel loops.Computed tomography revealed multiple dilated fluid filled small bowel loops suggestive of subacute small bowel obstruction. Herniation of the small bowel loops into the POD is noted.MRI revealed the small bowel loops in POD herniating through fornix into the vagina. Intraoperatively , small bowel loops were seen herniating through a defect in the POD on the right side into the fornix and formed a sac within the vagina. A sealed perforation was seen within the herniated loop and short segment gangrene was identified. Resection and anastomosis of bowel loop along with closure of defect in broad ligament defect was done. Conclusion: Pelvic hernia through the defect in cul-de-sac is very rare and high clinical suspicion is needed to diagnose this rare condition. Radiological knowledge of this rare entity in a patient with small bowel obstruction aids in early diagnosis and intervention avoiding the complications of bowel ischemia.

113 Exploratory laparoscopy in suspected bowel obstruction secondary to a transmesenteric hernia

Abstract Background Transmesenteric hernias (TH) in adults are an uncommon subtype of internal hernia that can be life-threatening because of the risk of bowel ischemia if not correctly diagnosed. Case report A 79-year-old man came to the emergency department with abdominal pain associated with vomiting and constipation for 24 hours. Physical examination showed no alarm signs. However, due to the presence of leukocytosis with neutrophilia and an abdominal X-ray with suspected obstruction, an abdominal CT scan was requested. Given the radiological finding of a defect in the mesentery through which a portion of the mesentery and several loops of bowel were introduced, an exploratory laparoscopy was indicated on suspicion of TH. Intraoperatively, 150 cm from the ileocecal valve, a 30 cm congestive segment of jejunum was observed, which was inserted in a 4 cm long eyelet in the omentum. Reduction of the herniated small bowel loops through the eyelet was performed without difficulty, observing good viability of the loops, and the eyelet was opened with scissors leaving the omentum open at the distal end. The patient was discharged on the 5th postoperative day tolerating oral diet, with transit and the surgical wound without signs of infection. Conclusion Although CT is the best diagnostic test for TH its preoperative diagnosis remains difficult. In the case of suspected TH, early exploratory laparoscopy is a correct technique that can preserve the viability of the bowel.

Congenital internal hernia in the neonate: Case series with review of potential comorbidities and imaging findings

Internal hernias are a rare but serious complication that typically present in older children and adults and can be congenital or iatrogenic in origin. They are often difficult to diagnose due to their similar radiological and clinical presentation to more common abdominal pathologies. We describe three cases of congenital internal hernias presenting in preterm infants followed by a literature review of congenital internal hernias presenting shortly after birth. When presenting in the neonatal period, congenital internal hernias have been exclusively reported as transmesenteric type. The exact etiology of transmesenteric congenital internal hernias is unclear, but may be a result of vascular compromise to the mesentery creating a small defect in which bowel may become entrapped. Certain genetic factors may also play a role in increasing risk for congenital internal hernias as they can be comorbid with other pathologies. Delayed diagnosis postpones surgical treatment, increasing risk of hernia incarceration, strangulation, irreversible bowel ischemia, and long-term risks inherent to bowel resection. Multimodal imaging plays a key role in the evaluation of these infants by excluding many causes of neonatal intestinal obstruction, however, a definitive prospective radiologic diagnosis has not been reported to date. Radiographic findings and comorbidities associated with these cases can be used along with future reported cases to potentially aid in timely diagnosis.

Congenital trans-mesenteric hernia as a cause of small intestine strangulation in a dog

Congenital trans-mesenteric hernia as a cause of small intestine strangulation in a dog

Acute Small Bowel Obstruction Caused By Transmesenteric Hernia Strangulation In A Young Man: A Case Report.

We report a rare case of a 20 year old patient with a transmesenteric hernia leading to small bowel obstruction and intestinal necrosis. An intestinal resection removed the necrotic portion and the mesenteric defect. Then, an immediate end-to-end anastomosis was realized. Transmesenteric hernia is a rare but serious entity. The surgical management must be rapid because of the increased risk of intestinal necrosis. Keywords: Transmesenteric hernia, small bowel obstruction, intestinal necrosis

Transmesenteric Internal Abdominal Hernia: Multi-detector row computed tomography findings.

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The use of point-of-care ultrasound to guide clinical management in intra-abdominal hypertension.

The Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach to keep intra-abdominal pressure (IAP) ≤ 15mm Hg. The role of point-of-care ultrasound (POCUS) as a bedside modality in the critical care patients is not well studied in relation to the intra-abdominal hypertension (IAH) management algorithm. To test the role of point-of-care ultrasound (POCUS) in the medical management of patients with intra-abdominal hypertension (IAH). We conducted a prospective observational study. Those who met the inclusion criteria were assigned to undergo POCUS and small bowel ultrasound as adjuvant tools in their IAH management. A total of 22 patients met the inclusion criteria and were included in the study. The mean age of the study participants was 65 ± 22.6years, 61% were men, and the most frequent admission diagnoses were hepatic encephalopathy and massive ascites (five cases). Ultrasound and abdominal X-rays were comparable in confirming correct NGT position, but the ultrasound was superior in determining the gastric content (fluid vs. solid) and diagnoses of gastric paresis in two cases. Small bowel obstruction was present in four patients and confirmed with abdominal CT; two of the patients underwent surgical intervention for mesenteric vessel occlusion and transmesenteric internal hernia. Enema treatment was found to empty the bowel incompletely 72%, 56%, and 42% of the time on days 1, 2, and 3, respectively. Four patients with cirrhosis admitted with upper gastrointestinal bleeding and hepatic encephalopathy (out of a total of 8) were found to have large amounts of ascites, and US-guided paracentesis was performed. POCUS can be used in the nonoperative management of IAH. It is an important tool in the diagnosis and treatment of patients with IAH.

Fatal occlusion on a congenital transmesenteric small bowel internal hernia: An autopsy case report

Summary Transmesenteric internal hernia is a clinically difficult diagnosis due to intermittent, non-specific symptoms and scant findings on clinical examination. In case of strangulation or incarceration, misdiagnosis of this entity can lead to death. We report a fatal case of transmesenteric internal hernia, complicated by small bowel occlusion, and discovered only at autopsy. The case addressed a misdiagnosed 16-year-old patient who complained of simple abdominal pain diagnosed as banal by two different doctors. True diagnosis was made only on pathological examination. Transmesenteric internal hernia can be easily missed and should be suspected in patients with acute abdominal pain associated or not with an occlusive syndrome, mainly in the young population.

ÇOCUKLARDA İLEUSUN NADİR NEDENİ TRANSMEZENTERİK İNTERNAL HERNİ; OLGU SUNUMU

İleus, barsağın fonksiyonel veya mekanik obstrüksiyonu sonucu ortaya çıkan yaygın bir klinik durumdur. Transmezenterik internal herni mekanik bir ileus nedeni olup, nadir görülür. İnternal herni, abdominal organların karın boşluğu içindeki konjenital veya edinsel bir açıklığa doğru ya da retroperitoneal bir fossaya doğru fıtıklaşması şeklinde meydana gelir. Klinik olarak hafif abdominal kramp ağrısından yaygın karın ağrısına ve ileus bulgularına kadar değişen semptom ve bulgular meydana gelebilir. Radyolojik tetkikler operasyon öncesi doğru tanıya katkı sağlayabilir, ama sıklıkla tanı ameliyat sırasında konulur. Altı yaşında ileus tablosuyla gelen peroperatif internal transmezenterik herni saptanan kız hastanın klinik ve medikal seyrini literatür bilgileri eşliğinde sunmayı amaçladık.

TRANSMESENTERIC HERNIA IN A PERIPARTUM PATIENT: AN UNUSUAL DIAGNOSIS

Congenital transmesenteric hernia is a very rare cause of intestinal obstruction in adulthood. We report a patient who came to the emergency with persistent abdominal pain post-emergency cesarean section and subsequently diagnosed to have acute pancreatitis based on computed tomography findings and elevated pancreatic enzymes. The pain was disproportionate to the diagnosis of pancreatitis and her condition rapidly got worsened requiring multiorgan support. Reimaging revealed obstructed transmesenteric hernia. The patient required immediate surgical intervention. A high index of the suspicion of internal hernia as one of the differential diagnoses of any atypical acute abdomen and early intervention could be lifesaving.

Congenital transmesenteric internal hernia; A rare cause of bowel ischemia in adults: A case report

Konjenital transmesenterik fitiklar, nadir gorulen ve yayinlanmis literaturde az sayida bildirilmis vaka ile eriskinlerde nadir gorulen bir barsak tikanikligi ve barsak iskemi nedeni olan cok kucuk bir ic fitik grubunu temsil eder. Hastaligin preoperatif tanisi zordur, erken mudahale ve cerrahi duzeltme, icsel fitik vakalarina bagli yuksek morbidite ve mortaliteyi onlemede uzun bir yol kat eder. Daha once cerrahi oykusu veya travmasi olmayan 31 yasinda bir kadin hastada gercek konjenital transmesenterik herni olgusunu sunuyoruz. Siddetli karin agrisi oykusu ve hem diski hem de flatusun kesilmesi ile basvurdu. Abdominal BT taramasi taniyi dogrulayamadi. Hasta abdominal agrinin artmasi ve sokla iliskili distansiyon nedeniyle ameliyat edildi. Bir kesif laparotomisi, barsak ilmeklerinin fitiklandigi ve kangrenli hale gelen dogustan bir transmesenterik defekti ortaya cikardi, rezeksiyona ve bir stomi turu Bouilly Volkmann'a neden oldu.

Transmesenteric Hernia in Extremely Low Birth Weight Infant: Case Report and Literature Review

Transmesenteric Hernia in Extremely Low Birth Weight Infant: Case Report and Literature Review

Transmesenteric hernia: A rare cause of bowel obstruction in pregnancy

Transmesenteric hernia: A rare cause of bowel obstruction in pregnancy

An Unlikely Cause of Bowel Obstruction in a Woman With Scleroderma

Systemic sclerosis is a multisystem disease that is characterized by vasculitis of the small arteries and fibrosis of the skin and other organs. The gastrointestinal system is the most frequently affected organ system in patients with systemic sclerosis, affecting 70-90% of patients. Gastrointestinal manifestations most commonly involve the esophagus but can also affect the entire GI tract from mouth to anus in the form of GERD, gastroparesis, pseudoobstruction, secondary small intestinal bacterial overgrowth (SIBO) and malabsorption. This is a case of a 59 year old woman with scleroderma, gastroparesis, SIBO, pseudoosbtruction. Her symptoms worsened and required a hospitalization and was found to have a cecal volvulus. She was taken to the operating room and the volvulus was reduced and no bowel resection was performed. This volvulus reoccurred four months later but resolved with conservative management. Over the following months, she developed an iron-deficiency anemia and underwent EGD and colonoscopy. Colonoscopy revealed a twist in the ascending colon and could not be traversed to the cecum. Within the twist was a flat polyp diagnosed as being a tubulovillous adenoma with high-grade dysplasia. She was referred to surgery for partial colectomy. In the operating room, she was found to have colonic distension and was found to have a mesenteric defect through which the colon herniated. She underwent an extended right sided colon resection. Large bowel obstruction due to trans-mesenteric internal hernias are exceedingly rare and has a reported incidence between 0.2 - 0.9%. This is a difficult diagnosis to make even with imaging studies and many times is found during the operation. In this case, her first operation did not identify the mesenteric defect and was a presumed volvulus secondary to her scleroderma. Therefore, trans-mesenteric internal hernias are a difficult diagnosis to make and often times require an exploratory laparotomy.

Congenital transmesenteric hernia presenting as neonatal ascites

Abstract Transmesenteric hernia is an internal hernia without sac, which forms through a congenital mesentery defect. Mostly diagnosed intraoperatively, it as a variable prognosis, which can lead to high morbidity and mortality. The authors describe a case of transmesenteric hernia that presented as isolated fetal ascites. A 34 week preterm baby was delivered by forceps, with respiratory compromise due to abdominal distension. Orotracheal intubation and evacuation paracentesis were performed. After excluding major causes of neonatal ascites and persistent bowel loop distension, the newborn underwent an exploratory laparotomy, where a transmesenteric hernia and pellets of meconium were identified. Hernia reduction, enterectomy and enterostomies were performed, with good outcome. Cystic fibrosis was diagnosed during post-operatory period. This is the first reported case of transmesenteric hernia presenting as fetal ascites, without associated morbidity or mortality due to an early intervention.

Intrahepatic intestinal loop through a congenital mesenteric hernia

Abstract Congenital internal mesenteric hernia is a rare cause of intestinal obstruction in the newborn. We report on a new unusual feature of combined internal transmesenteric hernia with intrahepatic location of the intestinal loop. We present also our controversial therapeutic approach based on the intention to finally resolve the problem of internal hernia in the newborn.

Congenital transmesenteric strangulated hernia in a neonate: a case report.

Congenital transmesenteric strangulated hernia in a neonate: a case report.

A Rare Case of Congenital Transmesocolic Hernia in an Adult Patient causing Small Bowel Strangulation

In adults, a congenital transmesenteric hernia is a rare cause of obstruction of the small bowel. It should be considered in the differential diagnosis in adults presenting with intestinal obstruction without any obvious external hernia or trauma or past abdominal surgery. We present a 55-year-old woman who had severe upper abdominal pain. On laparotomy, a mesenteric defect in sigmoid mesocolon with herniated necrotic ileum was found. The gangrenous small bowel was resected and the defect in mesentery was repaired.

MDCT signs predicting internal hernia and strangulation in patients presented to emergency department with acute small bowel obstruction

ObjectiveWe prospectively evaluate multidetector computed tomography (MDCT) criteria of internal hernia, and related complication as intestinal strangulation. Methods27 patients presented to emergency department with acute small bowel obstruction (ASBO) and diagnosed with MDCT as IH were included. Validity of different MDCT criteria in diagnosing IH was compared with surgical diagnosis. ResultsSurgical diagnosis was 22 patients with IH (14 paraduodenal and 8 transmesenteric hernia) and 5 false positive cases. There was excellent agreement between MDCT and surgery in diagnosing paraduodenal hernia (k=1), and good agreement in diagnosing transmesenteric hernia (k=0.624). Significant MDCT criteria include the following: cluster of small-bowel (p<0.0001); mass effect to surrounding (p=0.009); crowding of mesenteric vessels (Swirl's sign) (p=0.01). Sensitivity, specificity, PPV, NPV and accuracy of MDCT in diagnosing strangulation were 83%, 100%, 100%, 95%, and 96% respectively. MDCT signs for detecting strangulation were statistically significant and varied from highly significant for bowel-wall thickening and mesenteric vessel engorgement (p<0.001) to significant for abnormal bowel-wall enhancement, mesenteric infiltrate and mesenteric fluid with p value=0.001. ConclusionMDCT helps in early diagnosis of IH and strangulation, which accounts for appropriate management of such emergent cases.