Lesser sac herniation through the greater omentum and gastro-pancreatic ligament: report of a case

Internal hernia: complex diagnostic and therapeutic problem

INTRODUCTION

Internal hernias are neglected, life threatening and generally mismanaged surgical pathologies. They may be either acquired or congenital. The mortality and morbidity rates differ between the types and unfortunately reports investigating them are very rare, with limited number of patients, and mostly case reports. In this one of the largest series of the literature, we aimed to evaluate the resemblances and the differences between these two types.

METHODS

From January 2001 to April 2008, 25 patients who underwent surgery for an internal hernia were evaluated. Patients were divided into two groups; group I consisted of patients with acquired internal hernia, and group II with congenital internal hernia. The patients' records, imaging modalities, and operative findings were recorded and analyzed statistically.

RESULTS

Group I consisted of 16 patients whilst group II consisted of nine patients. There were no significant differences between the groups with regard to gender, patients' complaints, clinical and laboratory findings, imaging modalities, types of surgical procedures, and laparotomy time. Group I was significantly older, had significantly longer length of hospital stay (13.6+/-2.3 days versus 7.2+/-1.4 days) and had significantly higher postoperative mortality rate (43.8% in group I and 22.2% in group II, p<0.01).

CONCLUSION

Acquired IH is becoming the most prevalent type of IH. They usually have rapid progression to bowel ischemia, so they have bad outcome. High index of suspicion is mandatory since the main factors that may influence the prognosis of affected patients are early diagnosis and therapy.

Clinical spectrum of internal hernia: a surgical emergency

PURPOSE

To define the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center.

METHODS

We reviewed the medical records, imaging studies, and operative findings of 20 patients who underwent surgery for an internal hernia at our medical center between 1995 and 2005. The clinical characteristics and related indicators of the patients with, and those without bowel ischemia were compared and analyzed statistically.

RESULTS

The subtypes of congenital internal hernia (CIH) included transmesenteric (n = 6, 60%), paraduodenal (n = 2, 20%), and pericecal (n = 2, 20%) hernia. The abdominal surgical procedures preceding acquired internal hernia (AIH) were Roux-en-Y anastomosis (n = 6, 60%) and appendectomy (n = 3, 30%). Transmesenteric hernia was the most prevalent type of CIH in children. Abdominal rebound tenderness, advanced leukocytosis (>18 000/mm(3)), or a high level of manual band form (>6%) were the positive predictive factors for bowel ischemia, whereas a history of chronic intermittent abdominal pain was a negative indicator. No recurrence was noted during the 10-year study period. The overall mortality rate was 20%, attributable to enteral bacteria sepsis in all cases.

CONCLUSION

Internal hernia is a rare but lethal condition. Early diagnosis and prompt surgical intervention provide the only chance of a successful outcome.