A Case Report of Incarcerated Internal Hernia in Paracolic Gutter of the Descending Colon

Hiroyuki Kawasaki¹⁾⁴⁾, Kazuaki Sasaki¹⁾, Hajime Takasaka¹⁾, Keisuke Ohno¹⁾⁴⁾, Tsuyoshi Yabana²⁾, Ikuo Zenbutsu³⁾ and Kohichi Hirata⁴⁾

Department of Surgery, Doto Hospital¹⁾
Department of Intermedicine, Doto Hospital²⁾
Department of Surgery, Sapporo Satoh Hospital³⁾
Department of First Surgery, Sapporo Medical University⁴⁾

Incarcerated internal hernia is a relatively rare disease that occasionally presents as ileus, but usually does not have characteristic findings. Pre-operative diagnosis is very difficult. We experienced a rare case of an incarcerated internal hernia in a paracolic gutter of the descending colon. This is only the second such cases to be encountered in Japan. A 72-year-old woman who had visited to another hospital because of shizophrenia suddenly complained of abdominal pain and vomiting. An abdominal roentgenogram showed intestinal dilatations, and the patient was admitted for surgery. A contrast radiography showed a tapering and obstruction of the intestine on the left side of the abdominal cavity, and an internal hernia or pathognomonic adhesion was suspected. A definitive diagnosis could not obtained, however, and a laparotomy was performed under a diagnosis of ileus. The operative findings revealed that a part of the small intestine had protruded through a 1.5×1.5 cm defect of the paracolic gutter on the left side of the descending colon. The intestine was reduced to the abdominal cavity, and the hilus of the hernia was completely excluded. The patient has been well for the last 2 years.

Key words
internal hernia, small bowel obstruction, hernia of the paracolic gutter

Reprint requests
Hiroyuki Kawasaki Department of Surgery, Doto Hospital North 17 East 14, Higashi-ku, Sapporo, 065-8555 JAPAN

Accepted
May 27, 2003

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