Transmesenteric Hernia Research Articles

Transmesenteric hernia with bowel ischemia in unusual site

An 8-year-old girl presented with distal ileal obstruction secondary to transmesenteric hernia. The ileum just proximal to the herniated loop was ischemic, while the herniated bowel did not show ischemia. The ischemia was due to stretching and torsion of the vessels around the mesenteric defect by the herniated bowel. Such a mechanism has not been reported before.

RETROARTERIAL COLON WITH RIGHT-SIDED OBSTRUCTIVE GANGRENOUS COLITIS

Retroarterial colon is a rare entity in which the colon is located behind the superior mesenteric vessels. Transmesenteric internal hernias result in portions of the bowel protruding through a defect in the mesentery and are often acquired but may be congenital. We report a 10-year-old female with trisomy 13 who lacked retroperitoneal fixation of the intestines and had a retroarterial transverse colon possibly resulting from a congenital transmesenteric internal hernia, that eventually lead to obstructive gangrenous colitis.

Current Diagnostic Role of CT in Evaluating Internal Hernia

Transmesenteric hernia is frequently encountered in practice, and because of the high risk of strangulation, even small internal hernias are dangerous. Knowledge of the characteristic imaging features and the mechanism of internal hernia can lead to early detection and correct diagnosis, both of which can save the patient's life. This article describes common CT findings of internal hernia with emphasis on various postoperative transmesenteric hernias as well as other common internal hernias.

Traitement chirurgical des hernies rares

Uncommon intra abdominal hernias in adult represent the herniation of some length of bowel through an intra abdominal congenital orifice or an acquired peritoneal orifice. A wide range of clinical and anatomical features have been described despite their infrequency. Three types of hernias are usually observed, depending on the anatomy: herniation through a normal orifice including the Winslow's foramen; herniation through a pathologic orifice, such as transomental hernias, transmesenteric hernias, transmesocolic hernias and hernias trough the broad ligament; retroperitoneal hernias, mainly right or left paraduodenal, paracaecal or supravesical hernias. Epidemiology, pathology, clinical presentation, diagnosis and complications are shortly described for each type, along with surgical techniques.

P0737 DIFFERENT CLINICAL PICTURE OF STRANGULATED INTERNAL HERNIA IN CHILDREN; REPORT OF 3 CASES

Introduction: Internal hernia is the protrusion of viscous through a normal or abnormal opening within the abdominal cavity. With strangulation, high morbidity and mortality are usually associated, so early diagnosis and operation are essential. But, strangulated internal hernia is rare disease and clinical picture of it can be vague and atypical, so diagnosis is often an enigma in a clinical situation. We report 3 cases of strangulated internal hernia, manifested as acute abdomen with different clinical outcomes. Methods: We reviewed and summarized medical records of patients who were managed as strangulated internal hernia at Ilsan Paik Hospital, Korea, from March 2002 to May 2003. Results: Case 1: A 7-year-old girl was admitted to our hospital for acute abdominal pain and vomiting. Physical examination found severe abdominal tenderness and focal rebound tenderness. Plain films and abdominopelvic CT scan revealed nonspecific findings. But, 3 days later, follow up plain films showed multiple air-fluid level and fixed bowel loop. With exploratory laparotomy, a part of ileum incarcerated by transmesenteic hernia was identified, so 55 cm of ileum was resected. The patient was discharged on the 15th postoperative day and showed no long-term complication until now. Case 2: A 5-year-old girl visited emergency room, having vomiting and abdominal pain. Physical examination revealed mild abdominal tenderness but no rebound tenderness. Plain films showed multiple air-fluid level and abdominopevic CT scan revealed mesenteric hernia. Emergency laparotomy was performed. Almost all small bowel was incarcerated by transmesenteric hernia and most of the lesions including ileocecal valve were resected. The patient was discharged on the 11th day. She was currently managed for short bowel syndrome with out-patient schedule. Case 3: A 9-year-old boy visited emergency room for acute abdominal pain. His abdominal examination revealed mild focal tenderness, but did not show rebound tenderness and any other peritoneal irritation sign. Plain films and abdominal ultrasound showed nonspecific finding except ileus. After several hours with hydration and clinical observation, abdominal pain waned. But, later on the general ward, he had sudden cardiopulmonary arrest and was immediately resuscitated and transferred to ICU. Finally, he expired after 4-day. At autopsy, strangulated paraduodenal hernia with large hernia sac was notified. Conclusion: Clinical picture of strangulated internal hernia is quite diverse, so high index of suspicion is important for doctors managing children with acute abdomen. As in our cases, preoperative diagnosis may be difficult, so further useful diagnostic approach should be developed to reduce morbidity and mortality.

CT Findings of Congenital Transmesenteric Hernia: Case Report

Transmesenteric hernia occurs usually in adult patients who had history of an abdominal surgery or blunt abdominal trauma. Congenital mesenteric defect is a relatively common cause of internal hernia in children. However, the report of CT findings of congenital transmesenteric hernia is relatively rare. Thus, we report a case of congenital transmesenteric hernia occurring in a 13-year-old girl with intestinal obstructive symptoms, and include the CT findings.

外傷性腸間膜欠損孔への内ヘルニアにより遅発性に小腸壊死をきたした１例

外傷性腸間膜欠損孔への内ヘルニアにより遅発性に小腸壊死をきたした１例

Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia.

To evaluate the performance of radiologists in the diagnosis of internal hernia with specific computed tomographic (CT) findings. Abdominal CT scans obtained in 42 patients were retrospectively reviewed by three radiologists. The case group consisted of 18 patients with internal hernias (two paraduodenal, 16 transmesenteric); the comparison group was 24 patients with no internal hernia. Images were reviewed in a random and blinded fashion. Individual and group performance was evaluated with receiver operating characteristic (ROC) analysis, and interobserver agreement was measured with Cronbach coefficient alpha. Individual CT signs relevant as predictors of transmesenteric hernia were identified with logistic regression analysis and ranked by their odds ratio and P values. Both paraduodenal hernias were diagnosed by all readers on the basis of CT signs, including a retrogastric saclike mass of small-bowel loops. Diagnosis of transmesenteric hernia was more difficult and variable, with an average accuracy of area under the ROC curve (A(z)) of 77%, sensitivity of 63%, and specificity of 76%. CT signs of transmesenteric hernia were recognized consistently (Cronbach coefficient alpha >or= 0.80) and included a cluster of dilated small-bowel segments and stretching and displacement of mesenteric vessels. Coexisting volvulus and ischemia were diagnosed with low sensitivity (46% and 43%, respectively) but high specificity (96% and 98%, respectively). Diagnosis of internal hernia with CT remains difficult. Special attention should be given to the clustering of bowel loops, the mesenteric vessels, and signs of small-bowel obstruction.

Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria.

To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis. Retrospective review of medical records revealed 17 patients with surgically proved internal hernia (three paraduodenal, 14 transmesenteric) who had 15 computed tomographic (CT) scans and three small-bowel follow-through (SBFT) images. CT signs common to all types of internal hernia included evidence of small-bowel obstruction; clustering of small bowel; stretched, displaced, crowded, and engorged mesenteric vessels; and displacement of other bowel segments, especially the transverse colon and fourth portion of the duodenum. Left-sided paraduodenal hernias demonstrated a sac-like mass of small-bowel loops interposed between the stomach and pancreatic tail and a posterior mass effect on the stomach. All three paraduodenal hernias were diagnosed confidently at retrospective review of CT and SBFT findings. Transmesenteric hernias demonstrated clustered small-bowel loops adjacent to the abdominal wall without overlying omental fat and central displacement of colon and were frequently complicated by small-bowel volvulus (five of 14) and bowel ischemia (six of 14). CT demonstrated signs of volvulus in four of six patients with ischemia. CT findings considered definitive or suggestive of internal hernia were demonstrated in 15 patients. Internal hernia is an important and underdiagnosed condition. Transmesenteric hernia is most common in our experience and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis. CT may allow confident diagnosis in most patients.

Gasless laparoscopically assisted colonic surgery

Background: Laparoscopic technique has been applied to a variety of colonic and rectal operations, generally using carbon dioxide insufflation (CDI). However, CDI is inevitably associated with cardiopulmonary loading and can cause complications. The objective of this study was to determine the feasibility of gasless laparoscopic colonic surgery.Methods: The abdominal wall was lifted up using an originally designed retractor. A small incision, 3 to 5 cm in length, was made at the start of the operation. The surgeon operated through this incision using both conventional and laparoscopic instruments.Results: Operations were undertaken in 67 patients. In 6 patients (9%), conversion to open surgery was necessitated. In the remaining 61 patients, operations were completed with gasless laparoscopically assisted technique. Four reoperations (7%) were performed because of postoperative bleeding, anastomotic rotation, anastomotic stricture, and transmesenteric hernia. Fifty-three patients with colonic cancer were operated on with potentially curative intent. Of these, 1 (2%) developed hepatic recurrence during the mean follow-up period of 23.8 months. There was no port site recurrence.Conclusions: Gasless laparoscopic colonic surgery is technically feasible. CDI is not necessary to perform minimal access surgery.

A CASE OF TRANSMESENTERIC HERNIA ASSOCIATED WITH POSTOPERATIVE SMALL-BOWEL INSSUSCEPTION

Transmesenteric hernia is a relatively rare entiry and nearly 130 cases have been reported in Japan so far. We describe a case of transmesenteric hernia with postoperative intussusception. A 14-year-old boy was admitted to the hospital because of epigastralgia lasting for one day, followed by vomiting and abdominal pain at the periumbilical region on the next day. He had no previous history of abdominal operation. In the next morning after admission, he had severe abdominal muscle guarding, then underwent an emergency surgery. A defect of mesoileum with the size of 4cm in diameter was found at the 80cm from the end of ileum, and the ileum about 70cm in length from the end of ileum had protruded through the defect. The herniated intestine was pulled out, and the defect was closed. This ileum was not excised because of no gangrenous lesion in the affected intestine. The abdominal distention was observed 10days after the operation. An abdominal radiogram showed niveau sign of the small intestine, and antegrade small bowel series with contrast medium (Gastrographin®) through a nasointestinal tube showed the coil spring sign. Under the diagnosis of postoperative small-bowel intussusception, the patient was reoperated on. The intestines adhered to the peritoneal wound and mildly distended, but the appearance of the intestine was almost normal. The intussusception of the intestine was easily repaired by Hutchinson maneuver. The second postoperative course was uneventful. A transmesenteric hernia is rare, however, we should take notice it when we encounter the mechanical bowel obstruction.

A case of transmesenteric hernia associated with small intestinal strangulation in an adult

A case of transmesenteric hernia associated with small intestinal strangulation in an adult

INTERNAL HERNIA

HARVEY B. STONE,1referring specifically to abdominal hernias, tersely stated: one essential conditionfor the existence of hernia is a defect in the containing and restraining structures of the abdomen which permits its contents to protrude beyond their normal limits. Transmesenteric hernias, not possessing a hernial sac but consisting merely of a protrusion of a loop of bowel or omentum through a hole in the mesentery, like most other internal hernias, barely fulfil the one essential condition mentioned. VARIETIES There are many varieties of abdominal hernia. The containing structures of the abdomen comprise the most common varieties, including direct and indirect inguinal, femoral, umbilical, ventral, diaphragmatic, lumbar, obturator, sciatic and perineal hernias. The restraining structures of the abdomen comprise most of the varieties of internal hernia, such as paraduodenal, cecal and intersigmoid hernias, hernia into the foramen of Winslow and hernias through defects or holes in the mesocolon

Pregnancy complicated by transmesenteric hernia

Acute intestinal obstruction appearing during pregnancy is uncommon. An internal hernia producing acute intestinal obstruction is rare. A patient who was early in pregnancy and who suffered an internal hernia was successfully treated surgically and was later delivered of a normal, living male.

Obstructed Transmesenteric Hernia

Obstructed Transmesenteric Hernia

Acute Intestinal Obstruction Due to Transmesenteric Hernia of the Small Bowel

Acute Intestinal Obstruction Due to Transmesenteric Hernia of the Small Bowel