Transmesenteric Internal Hernia Research Articles

Internal hernia following laparoendoscopic single site surgery: a case report

Laparoscopic donor nephrectomy was introduced in 1995 as a means of minimally invasive surgeries that entail kidney extraction from healthy individuals. Since then, it has widely overtaken the traditional open surgical approaches, especially in live donor nephrectomy procedures worldwide. Laparoendoscopic single-site surgery is considered a more optimized surgical approach utilizing a single incision instead of four. Various studies have scrutinized many of the risk factors related to such surgeries, most commonly: vascular problems, intraoperative organ injury, and postoperative ileus. Other rare complications have not been thoroughly explored due to their decreased prevalence. Internal hernias are considered a rare complication of laparoendoscopic single-site surgery with dangerous repercussions ranging from bowel obstruction to ischemia, and necrosis. Our study presents a rare case of a trans-mesenteric internal hernia following laparoendoscopic single-site surgery. The patient was relatively healthy with no serious medical conditions. However, the past medical history did record a diagnosis of irritable bowel syndrome a few years back. Knowing that the occurrence of internal hernias is infrequent, we recommend that mesenteric defects be taken seriously to avoid the risk of internal hernias and their complications.

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.

A Case of Strangulated Ileus Associated with an Adult Transmesenteric Internal Hernia

A Case of Strangulated Ileus Associated with an Adult Transmesenteric Internal Hernia

Transmesenteric (Internal) Hernia with an Ileal Volvulus in Pregnancy: A Case Report and Literature Review

Abstract: Introduction: Transmesenteric hernia describes an internal abdominal herniation through an opening in the mesentery. It is a very rare finding especially in pregnant women. Case Report: We report a case of acute intestinal obstruction in a 30-year-old pregnant woman with a rare finding of transmesenteric hernia and gangrenous ileal volvulus at exploration. Despite a delay due to a precipitated labour and delivery successfully managed her. Conclusion: Clinicians when faced with similar features in a pregnant woman should consider transmesenteric hernia.

Sixty-Four-Slice Multidetector Computerized Tomography in the Evaluation of Transmesenteric Internal Hernias following Roux-en-Y Bariatric Surgery

Objective: To evaluate the accuracy of 64-slice multidetector computerized tomography (MDCT) in the detection of transmesenteric internal hernias in patients following Roux-en-Y gastric bypass (RYGB) for bariatric surgery patients. Subjects and Methods: This retrospective study was performed on post-bariatric RYGB patients presenting with signs and symptoms suggestive of internal hernias at our institution from the period of April 2010 until March 2012. The patients who had symptoms suggestive of internal hernia had undergone 64-slice MDCT. All the patients who on CT examination were found to have features suggestive of internal hernia were subjected to laparoscopic exploration. Results: Of the 102 patients who had undergone laparoscopic RYGB, 42 (41.2%) were suspected of having internal hernia. Of these, 23 (55%) had CT findings of hernia while the remaining 19 (45%) were considered normal. Of the 23, 21 (91%) patients were confirmed for internal hernia at laparoscopy. The 19 (45%) patients that did not reveal any signs for internal hernia on CT and the 2 patients that were considered normal on laparoscopy were treated conservatively. The sensitivity, specificity and positive and negative predictive values for MDCT in the diagnosis of internal hernias were 100, 90.5, 91 and 91.3% respectively. Conclusion: The 64-slice MDCT was accurate in the diagnosis of transmesenteric internal hernias in post-RYGB for bariatric surgery patients. The presence of clustered loops with mesenteric swirl is a reliable indicator of transmesenteric internal hernia.

Cholestasis as the leading sign of a transmesenteric hernia in a split‐liver transplanted child – A case report and review of literature

Internal hernias are an extremely rare complication after pediatric liver transplantation, and its presentation with cholestasis has not been described to date. We report the case of a 12-yr-old boy who presented with moderate abdominal pain 11 yr after split liver transplantation and biliary-enteric anastomosis. He developed severe jaundice within 24 h of initial presentation. Imaging studies revealed ascites, dilation of the intrahepatic bile ducts, a dilated Roux-en-Y-loop, with the loop truncated at the level of the mesenteric artery, which performed a narrow right-to-left loop. At laparotomy, a transmesenteric internal hernia at the root of the jejunal mesentery was identified, originating from the creation of the Y-loop; the Roux-en-Y-loop and its adjacent intestinal loops had slipped through the opening. The Roux-en-Y loop was ischemic from strangulation, and the rest of the intestine well perfused. No surgical resection was necessary following reduction. The patient recovered completely. We discuss diagnosis and management of internal hernias, and review radiological signs. Internal transmesenteric hernias can occur at any time after liver transplantation and prompt diagnosis and surgical treatment are vital.

Congenital transmesenteric internal hernia — A case report with literature review

Congenital transmesenteric internal hernia is a rare condition presenting as recurrent pain abdomen or acute intestinal obstruction. Preoperative diagnosis of internal hernia is very rare. Early intervention and surgical correction goes a long way in preventing high morbidity and mortality associated with cases of internal hernia. We report a case of congenital transmesenteric intra-abdominal hernia presented as acute abdomen with timely surgical intervention in the form of emergency laparotomy with untwisting and reduction of small bowel herniated through large congenital terminal ileal mesenteric defect and repair of mesenteric defect.

MRI appearance of internal hernia following Roux-en-Y gastric bypass surgery in the pregnant patient

In recent years, there has been a dramatic increase in the number of bariatric surgeries performed for the management of morbid obesity, 1 Lockhart M.E. Tessler F.N. Canon C.L. et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007; 188: 745-750 Crossref PubMed Scopus (145) Google Scholar with Roux-en-Y gastric bypass (RYGB) comprising the most frequent such surgery performed in the United States. 2 Kakarla N. Dailey C. Marino T. et al. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol. 2005; 105: 1195-1198 Crossref PubMed Scopus (68) Google Scholar , 3 Efthimiou E. Stein L. Court O. et al. Internal hernia after gastric bypass surgery during middle trimester pregnancy resulting in fetal loss: risk of internal hernia never ends. Surg Obes Relat Dis. 2009; 5: 378-380 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar A recognized complication of RYGB is the development of a transmesenteric internal hernia, in which a loop of small bowel herniates through a surgically created mesenteric defect. Although an internal hernia in this setting is challenging to diagnose clinically given the non-specific and often subtle presentation, a delay in diagnosis and operative treatment may result in dire consequences, including bowel incarceration, ischaemia, gangrene, sepsis, and possibly death. 2 Kakarla N. Dailey C. Marino T. et al. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol. 2005; 105: 1195-1198 Crossref PubMed Scopus (68) Google Scholar , 4 Naef M. Mouton W.G. Wagner H.E. Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009; PubMed Google Scholar , 5 Ahmed A.R. O'Malley W. Internal hernia with Roux loop obstruction during pregnancy after gastric bypass surgery. Obes Surg. 2006; 16: 1246-1248 Crossref PubMed Scopus (36) Google Scholar There has been increasing awareness by the radiology community of the risk of internal hernia following gastric bypass surgery, as well as of the critical nature of establishing the diagnosis, with numerous recent studies in the radiology literature demonstrating the ability of computed tomography (CT) to diagnose an internal hernia following RYGB. 1 Lockhart M.E. Tessler F.N. Canon C.L. et al. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol. 2007; 188: 745-750 Crossref PubMed Scopus (145) Google Scholar , 6 Blachar A. Federle M.P. Dodson S.F. Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology. 2001; 218: 68-74 Crossref PubMed Scopus (254) Google Scholar , 7 Martin L.C. Merkle E.M. Thompson W.M. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006; 186: 703-717 Crossref PubMed Scopus (317) Google Scholar , 8 Merkle E.M. Hallowell P.T. Crouse C. et al. Roux-en-Y gastric bypass for clinically severe obesity: normal appearance and spectrum of complications at imaging. Radiology. 2005; 234: 674-683 Crossref PubMed Scopus (54) Google Scholar , 9 Sandrasegaran K. Maglinte D.D. Lappas J.C. et al. Small-bowel complications of major gastrointestinal tract surgery. AJR Am J Roentgenol. 2005; 185: 671-681 Crossref PubMed Scopus (17) Google Scholar

A Case of Strangulated Ileus Due to a Transmesenteric Internal Hernia

A Case of Strangulated Ileus Due to a Transmesenteric Internal Hernia

Small Bowel Obstruction in Children: Usefulness of CT for Diagnosis and Localization

Purpose: To evaluate the usefulness of CT for the diagnosis of the cause and localization of small bowel obstruction. Materials and Methods: Out of a group of children who underwent a CT examination for a suspected small bowel obstruction, 19 patients with confirmed underlying disorders were identified and included in the study. Neonates and patients with duodenal obstruction were excluded from the study. The CT findings were analyzed for the location of obstruction site, abnormalities of the mesentery and mesenteric vessels, bowel wall thickening, closed loop obstruction, and strangulation. The obstruction site was divided into five parts. The preoperative CT diagnosis was compared with the final diagnosis. Results: Causes of small bowel obstruction were intussusception (n = 6), appendiceal perforation (n = 4), transmesenteric internal hernia (n = 2), postoperative bands (n = 1), idiopathic multiple bands (n = 1), a foreign body (n = 1), a small bowel adenocarcinoma (n = 1), Meckel's diverticulitis (n = 1), tuberculous peritonitis (n= 1) and Salmonella enteritis with bowel perforation (n = 1). The CT findings showed mesenteric vascular prominence (n = 13), omental or mesenteric infiltration (n = 10), localized bowel wall thickening (n = 7), closed loops obstruction (n = 3) and strangulation (n = 1). The obstruction site was identified in all cases. The causes of obstruction could be diagnosed preoperatively in 14 cases, but a preoperative diagnosis was difficult in 5 cases. Conclusion: The causes of small bowel obstruction in children are variable, and CT is useful for evaluating the cause and localization of small bowel obstruction.

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.

A CASE OF TRANSMESENTERIC INTERNAL HERNIA WITH NECROSIS OF THE SMALL INTESTINE

A 22-year-old woman was admitted to another hospital because of lower abdominal pain. she underwent a laparotomy under a diagnosis of torsion of the ovarian cyst. During surgery, necrosis of the small intestine was found, and she was immediately transferred to the hospital. Abdominal CT scan showed that the small intestine with thick wall was markedly distended and filled with fluid and air. C-shaped, fluid-filled small-bowel loop with a twisted mesentery was also seen. At emergency operation, we found that the small intestine was incarcerated into an abnormal defect in the mesentery in the ileum and the incarcerated intestinal loop was twised along its long axis. Necrotic bowel by 150cm was resected and the defect was closed. Postoperative course was uneventful. Adult transmesenteric internal hernia is a relatively rare disease. This paper presents our case with some bibliographical comments on 13 cases which have been seen in the Japanese literature.