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Coronal CT demonstrating dilated small bowel with a transition point 10 cm from the ileocaecal valve. (Arrow).
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Internal hernias are a rare cause of small bowel obstruction and are estimated to account for 1% to 5% of cases. Herniation through a defect in the sigmoid mesocolon constitutes 6% of all internal hernias.
In this case report we describe a rare case of a fit and healthy 60-year-old man, with no previous history of abdominal surgery, who presented w...
Citations
... SIO is defined as intestinal obstruction with compromised intestinal blood flow and can be caused by a fibrous cord, torsion, internal hernia, or adhesions due to previous abdominal surgery. OIE is a serious condition that requires early diagnosis and immediate surgery because intestinal ischemia due to strangulation of the intestine can lead to necrosis of the intestine and even perforation, which can cause septic shock 4 . In terms of OIE, a late intervention has a high risk of mortality, and the mortality rate is reported to be 16% 4 . ...
Small bowel obstruction (SBO) is one of the most common causes of hospitalization and internal hernias represent a very rare etiology (0.2-0.9%). The most common manifestations include abdominal pain, nausea, and vomiting. SBO can progress to strangulated intestinal obstruction (SIO), a serious condition that requires early diagnosis and emergency surgery. We report the case of a SIO with septic shock in a 73-year-old female with comorbidities and a history of previous surgeries, which required emergency surgery with intestinal resection and discharge of the patient without complications.
... As with other types of internal hernias, excessive length of the small intestine mesentery and increased mobility of the intestines may predispose individuals to develop intersigmoid hernias [6]. Finally, some literature asserts that the intersigmoid fossa becomes smaller over time, and therefore the risk of developing an intersigmoid hernia is inversely associated with age [7,12]. ...
... Due to the rarity and lack of clear clinical or radiological features, intersigmoid hernias are often found, as in our case, during surgical exploration of the abdomen indicated for an acute small bowel obstruction [3][4][5][6][7][8][9][10][11][12][13]. CT scans may demonstrate sacculated loops of the intestine that occupy the left lower quadrant in combination with a medial displacement of the sigmoid colon [14]. ...
Bowel obstructions can be caused by internal hernias which are protrusions of the bowel into openings within the abdominal cavity. There are various types of internal hernias including sigmoid hernias which involve the sigmoid mesentery. Sigmoid hernias are very difficult to diagnose clinically, even with the aid of radiologic imaging. Computed tomography (CT) scan findings often reveal small bowel obstructions; however, they are not sensitive to intersigmoid hernias. Most of these rare herniations are repaired by open abdominal surgery followed by the closure of the mesenteric defect to prevent a recurrence. We present the case of a 57-year-old man who presented to the emergency department with a small bowel obstruction that was caused by an intersigmoid hernia and was successfully repaired through a minimally invasive laparoscopic approach. This case demonstrates an intra-operative diagnosis of an intersigmoid hernia and reviews the benefits of a laparoscopic approach for the reduction of the sigmoid mesentery.
... Blunt trauma injury to the sigmoid mesentery, unlike that to the small intestinal mesentery, has been reported only rarely. Eleven previous studies were identified by searching the PubMed database using the terms transmesosigmoid and hernia with no limits on the date of publication [1,3,[6][7][8][9][10][11][12][13][14] (Table 1). A few hypotheses about the etiology of mesenteric defects are available in these reports; however, there are no reports of patients with a history of trauma. ...
Introduction:
A transmesosigmoid hernia is defined as small bowel herniation through a complete defect involving both layers of the sigmoid mesentery. Blunt trauma injury to the sigmoid mesocolon has been reported only rarely. We herein report a case of a strangulated transmesosigmoid hernia associated with a history of a fall from a height.
Presentation of case:
A 43-year-old woman presented to our hospital for evaluation of vomiting. She had no history of abdominal surgery but had sustained a complete spinal cord injury and pelvic fracture secondary to a fall from a height 25 years earlier. A computed tomography scan of her abdomen and pelvis demonstrated a closed loop of small bowel in the pelvis, with a zone of transition in the left lower abdomen. Although the cause of the obstruction was difficult to establish, ischemia was strongly suspected; therefore, the decision was made to perform emergency exploratory laparoscopy. During laparoscopy, a loop of ileum was observed to have herniated through a full-thickness defect in the sigmoid mesocolon, consistent with a transmesosigmoid hernia. The herniated loop was strangulated but not gangrenous and was successfully reduced using laparoscopic graspers. The incarcerated small bowel appeared viable and was therefore not resected. The defect was closed with a running suture. The patient had an uneventful postoperative course with no recurrence.
Discussion and conclusion:
Abdominal blunt trauma can cause sigmoid mesenteric rupture resulting in a transmesosigmoid hernia. In the management of transmesosigmoid hernias, laparoscopic herniorrhaphy has the advantage of facilitating simultaneous diagnosis and surgical intervention.
... An internal hernia causing a small bowel obstruction is rare with studies reporting an incidence of one to five percent. 6 Internal hernias are more common in the pediatric population and seldom seen among adults. In children, internal hernias are usually congenital whereas in adults they are usually iatrogenic or caused by trauma. ...
Congenital mesenteric defects can lead to internal hernias which may result in a bowel obstruction. They are very rare among the adult population, comprising only 0.2%-0.9% incidence rate of all small bowel obstructions. A 40 year old woman presented to the Emergency Department with abdominal pain.Computed tomography scan was obtained and showed a small bowel obstruction.After failed conservative management with bowel rest and nasogastric tube decompression, the patient underwent diagnostic laparoscopy.An internal hernia was identified though a congenital mesenteric defect at the level of the sigmoid colon. The hernia was reduced and the defect closed. When a patient presents with abdominal pain the diagnosis of a congenital mesenteric defect with internal hernia should be considered with subsequent emergent surgical exploration.
... Intersigmoid hernia is the most common variety, which is herniation through the lateral aspect or to the left of the sigmoid mesentery into the intersigmoid fossa. Transmesosigmoid hernia is herniation of the bowel through an isolated oval defect in the sigmoid mesentery with involvement of both leaves of mesentery and lacks a hernial sac [4]. Intramesosigmoid hernia is the rarest of these three and is herniation of the bowel through an isolated oval defect, which may be situated in the sigmoid mesentery either on the medial aspect or lateral aspect adjacent to the sigmoid colon involving only one leaf of the sigmoid mesentery [5]. ...
Internal hernia, as the cause of acute intestinal obstruction, is rare and sigmoid hernia is not one of the most common
internal hernias. Moreover, intramesosigmod hernias are of the rarest variety. Establishing precise preoperative clinical
diagnosis is a challenge for a surgeon. Strangulated sigmoid hernia has high morbidity and mortality. Prompt exploration
has to be undertaken based on clinical signs and symptoms rather than searching for the exact cause of obstruction. Here,
an extremely rare case of intramesosigmoid hernia is presented with a defect in the medial leaf of the mesentery leading to small bowel obstruction.
... Collins et al [13] 60/M Van der Mieren et al [14] Postpartum woman Benson et al [19] 42/F Yao et al [20] 60/M Guo et al [21] 39/M ...
Transmesosigmoid hernia has previously been considered as a rare condition. The clinical symptoms can be nonspecific. Here, we report a case of acute intestinal obstruction because of transmesosigmoid hernia. In addition, after a comprehensive review of PubMed and China National Knowledge Infrastructure, we present a review of 22 cases of transmesosigmoid hernia. We summarize several valuable clinical features that help early recognition of transmesosigmoid hernia. As a result of easy strangulation, in patients without a history of surgery or abdominal inflammation who present with symptoms of progressive or persistent small bowel obstruction (SBO), surgeons should consider the possibility of transmesosigmoid hernia. In addition, based on our data, in patients with SBO because of transmesosigmoid hernia, the defect is usually 2-5 cm in diameter. Furthermore, because of the high risk of strangulation with transmesosigmoid hernia, it is mandatory to reassess the condition timely and periodically when patients receive conservative treatment.
... Finally, Perez Rouiz et al. showed that a transmesosigmoid hernia had developed due to pneumoperitoneum during previous laparoscopic surgery. Most of the defects are 2 to 4cm in diameter, with the area around the mesenteric defect being thin and weak [7][8]. ...
We report the case of a transmesosigmoid hernia in a 28-year-old female who presented to the emergency room complaining of abdominal pain. History, clinical and radiographic examination revealed small bowel ileus, but without being able to diagnose the cause. We decided to perform laparoscopy, which showed herniation of a small intestine loop through a small defect of the mesosigmoid. Due to the inability to reduce the internal hernia laparoscopically, we converted to mini-laparotomy; we reduced the hernia and performed segmental small bowel resection and anastomosis. It is essential to suspect the presence of an internal hernia as soon as possible, because if the operation is delayed, it will often eventually lead to bowel necrosis.
... Previously, paraduodenal hernias were regarded as the most common type of internal hernia; however, it has recently been reported that transmesenteric hernias are increasing in incidence [2]. Although transmesenteric hernias are increasing in incidence, transmesosigmoid herniation is very rare, especially in patients with no history of abdominal surgery or trauma [3]. ...
Internal hernias are an infrequent cause of small bowel obstruction with transmesosigmoid herniation being very rare, especially in patients with no history of abdominal surgery or trauma. Early surgical intervention is important in acute presentation to reduce the high morbidity and mortality rates associated with this disease.
Internal transmesosigmoid is a rare condition, that can cause unusual small bowel obstruction we report of an 80-year-old male patient presenting an acute intestinal obstruction due to transmesosigmoid hernia, the patient was operated for bladder lithiasis 6 years ago. Auscultation revealed intestinal borborygmus, and CT scan showed sigmoid volvulus in a dolichocolon. The diagnosis of acute intestinal obstruction was made, and an emergency laparotomy was indicated. Because of the high risk of strangulation with transmesosigmoid hernia, it is mandatory to timely and periodically reassess. Early surgical intervention is crucial to reduce mortality.
Internal hernia associated with small intestine obstruction is a rare disorder which is difficult to diagnose accurately prior to surgery. Among 172 cases undergoing laparotomy in our hospital under the diagnosis of ileus, internal hernia was seen in 7 patients, 2 men and 5 women whose age ranged from 15 to 86 years. An emergency laparotomy was performed within 24 hours after the diagnosis of small bowel obstruction or internal hernia in 4 patients and following bowel decompression with an ileus tube in 3 patients. Among 3 patients with the establishment of a preoperatively accurate diagnosis, 2 patients were diagnosed using multiplanar reconstruction MDCT images as having an internal hernia through a defect in the broad ligament of the uterus. The presence of transepiploic hernia in 1 patient, paracecal hernia in 1, intramesosigmoid hernia in 1, and a broad ligament hernia in 4 were confirmed under laparotomy. All of the 3 patients with high CT values on the mesenterium required small intestine resection. All but 1 case were discharged from hospital 6-32 days after surgery (median: 8 days). Multiplanar reconstruction MDCT images are useful for making an accurate diagnosis of internal hernia prior to surgery, and high CT values on mesenterium is an important sign of the necessity for resection of an incarcerated bowel.
