Two Cases of Incarcerated Internal Hernia

Toshihiko Waku, Kazuhiko Watanabe, Noriaki Tomioka and Yojiro Orita

Department of Surgery, Central Hospital

We report 2 cases of incarcerated internal hernia of appendix epiploica of the sigmoid colon and a small intestinal mesentery. Case 1: A 65-year-old woman admitted for abdominal pain and vomiting underwent conservative therapy using a long tube. Intestinal contrast studies through the tube and CT showed obstruction of the small intestine at the lower abdomen on day 4 after symptom onset. On day 6, we conducted surgery. The small intestine was incarcerated 130 cm proximal from the terminal ileum into a 2.5×2.5 cm defect in the appendix epiploica of the sigmoid colon. When the appendix epiploica was resected and ileus relieved, no necrosis was seen and no intestinal resection was needed. Case 2: A 19-year-old woman admitted for upper abdominal pain and vomiting was found in CT to have ascites and obstruction of the small intestine at the lower abdomen on day 2 after symptom onset. Surgery was done under a preoperative diagnosis of strangulated ileus. The small intestine was incarcerated 10 cm proximal from the terminal ileum into a small intestinal 3.0×3.0 cm mesenteric defect. After ileus was relieved, the necrotic ileum was resected and the defect in the small intestinal mesentery sutured closed. Incarcerated internal hernia of the appendix epiploica of the sigmoid colon has been reported only once in the Japanese literature to the best of our knowledge, and incarcerated internal hernia of a small intestinal mesentery in more than 15 years have amounted to only 32 cases in Japan. It is thought that preoperative diagnosis of internal hernia is difficult, but intestinal obstruction in a patient without history of undergoing surgery should be suspected of a possible internal hernia and we should not miss the opportunity for operation.

Key words
internal hernia, small intestinal mesentery, appendix epiploica

Reprint requests
Toshihiko Waku Department of Surgery, Saijo Municipal Shuso Hospital
131 Nyugawa, Saijo, 799-1341 JAPAN

Accepted
November 30, 2004

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