A Rare Case of Epiplo-Enterocele

Yoshihiro Tanaka, Naoki Yokoo, Michio Kimoto, Takashi Shiroko, Takahito Adachi, Takahiro Yoshida, Katsuaki Ura, Shinya Hamasu, Hiromitsu Nagata and Koji Kitamura

Department of Surgery, Takayama Red Cross Hospital

A 53-year-old man admitted for abdominal pain had no history of surgery or injury. An abdominal X-ray film showed niveau. Symptoms were not eliminated by conservative therapy using an ileus tube under a diagnosis of intestinal obstruction. At 24 hours after symptom onset, he experienced abdominal rebound tenderness, and was found in abdominal computed tomography to have fluid in the abdominal cavity and a C-shaped fluid-filled small-bowel loop with a twisted mesentery necessitating emergency surgery under a diagnosis of panperitonitis. During surgery, we found incarceration of the small bowel (the small intestine pushed its way from the space between the stomach and pancreas in the omental bursa with the greater omentum into a lesser sac space) and the proximal small bowel was dilated. We reduced the incarcerated ileum manually, and closed the hernia orifice since no circulation obstacle of the affected ileum was seen. The postoperative course was uneventful and the patient was discharged on postoperative day 9. It was difficult to diagnose the cause of intestinal obstruction as due to a slit of gastropancreatic physiologic adhesion, and we emphasize the need for rapid surgical intervention if strangulation or circulatory disturbance of the small intestine is indicated. The occurrence of internal hernia is rare, and we know of no other such case in Japan. Bibliographical comments are presented.

Key words
internalhernia, strangulation ileus, epiplo-enterocele

Reprint requests
Yoshihiro Tanaka Department of Surgery, Takayama Red Cross Hospital 3-11 Tenman-cho, Takayama, 506-0025 JAPAN

Accepted
January 22, 2003

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