Simultaneous small and large bowel obstruction as a consequence of internal hernia: A case report
| Autor: | Mohammad A. Al-Doud, Malek A Al-Omari |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Internal hernia
medicine.medical_specialty medicine.medical_treatment education Article Congenital trans-mesenteric hernia 03 medical and health sciences Ileostomy 0302 clinical medicine Laparotomy medicine business.industry Colostomy medicine.disease digestive system diseases Surgery Volvulus Bowel obstruction surgical procedures operative medicine.anatomical_structure Intestinal obstruction 030220 oncology & carcinogenesis Abdomen 030211 gastroenterology & hepatology business Abdominal surgery |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • There are no cardinal symptoms for internal hernia. • Internal hernia must be kept as a differential diagnosis in the case of intestinal obstruction in both operated and non-operated abdomen. • Early diagnosis both clinically and radiologically may prevent undesirable complications. • Both patient status and surgeon's experience are essential to form the best surgical decision. • Fine handling of bowel, assessment of viability, closure of defects and inspecting for other potential ones, and argumenting stoma formation are the main principles of surgery. Introduction Intestinal obstruction ascribed to internal hernia is quite rare, especially in adults. There are no differentiating features in the presentation of intestinal obstruction due to internal hernia as compared to other causes. Delay in the diagnosis of this condition carries a considerable risk especially in a virgin abdomen. We report a rare case of internal hernia which presented as acute small and large bowel obstruction. Presented case We report a 47- year- old male with generalized abdominal pain associated with vomiting and obstipation. The patient was in hypovolemic shock that only had a transient response to resuscitation. CT scans of the abdomen with contrast was done and showed both large and small bowel obstruction. Exploration laparotomy was done and revealed a concurrent nonviable portion of ileum and twisted sigmoid colon (volvulus) which protruded through a congenital transmesentric defect. Resection was mandatory, and repair of the defect was done. Discussion Incidence of internal hernia generally does not exceed 1%. The diagnosis of congenital internal hernia relies on absence history of trauma, inflammatory process and abdominal surgery. Protrusion of simultaneous small and large bowels together through transmesenteric congenital gate is uncommon. Conclusion Whether the patient presenting with intestinal obstruction has a history of undergoing previous surgeries (for any reason) or not, the diagnosis of internal hernia must be kept in mind. Coexisting involvement of both small and large bowels that need resection poses the question of the need for restoration of bowel continuity with either colostomy or ileostomy. |
| Databáze: | OpenAIRE |
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