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Matsuishi K, Saito S, Ohuchi M, Kiyozumi Y, Nasu J, Hanada N, Baba H. A case of internal hernia in the pararectal fossa. Surg Case Rep 2023; 9:178. [PMID: 37843687 PMCID: PMC10579196 DOI: 10.1186/s40792-023-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/02/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Internal hernias are relatively rare and difficult to diagnose. Diagnostic delays lead to the progression of strangulation. In particular, pararectal fossa hernias are extremely rare. We encountered a case in which internal hernia occurred in the pararectal fossa. CASE PRESENTATION An 87-year-old woman was referred to our hospital because of persistent lower abdominal pain and vomiting. Contrast-enhanced computed tomography revealed findings of intestinal ischemia, such as closed loop formation with reduced contrast effect on the left side of the rectum in the pelvis. Strangulation small bowel obstruction was diagnosed, and emergency laparotomy was performed. The small intestine was found to invade the peritoneal reflection on the left side of the rectum. The patient was finally diagnosed with pararectal fossa hernia. The incarcerated small intestine was released with no bowel resection. The 4-cm hernia phylum was observed and closed by simple suture. The patient had a good postoperative course without recurrence. CONCLUSIONS We encountered a very rare case of internal hernia in the left pararectal fossa. Preoperative diagnosis of this disease is difficult, but it should nevertheless be considered in cases in which the cause of the intestinal obstruction is unknown.
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Affiliation(s)
- Kozue Matsuishi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Seiya Saito
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Mayuko Ohuchi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Yuki Kiyozumi
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Jiro Nasu
- Department of Surgery, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan
| | - Norihisa Hanada
- Department of Surgery, Izumi General Medical Center, 520 Myozincho, Izumi City, Kagoshima, 899-0131, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
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Sajan A, Hakmi H, Griepp DW, Sohail AH, Liu H, Halpern D. Herniation Through Defects in the Broad Ligament. JSLS 2021; 25:JSLS.2020.00112. [PMID: 34248336 PMCID: PMC8241289 DOI: 10.4293/jsls.2020.00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background We sought to assess hernia characteristics and classification through comprehensive review of the literature involving broad ligament herniation. Methods A literature search via MEDLINE and Embase databases was conducted to identify and select broad ligament herniation studies published between January 1, 2000 and September 30, 2020. Extracted data included previous surgical history, previous obstetric history, diagnostic imaging, herniated organ, hernia classification, and repair performed. The reported data has been compared to a unique case of broad ligament herniation that presented to our institution. Results A total of 44 articles with 49 cases were identified for the study. Eighteen (36.7%) patients had a history of previous abdominal surgery while 29 (59.2%) had a history of previous childbirth. Type I (51.0%) and Type II (18.4%) defects were most commonly reported with most patients reporting only one defect (85.7%) using the Cilley classification. Twenty-nine patients underwent primary laparoscopic repair of the defect while 19 patients underwent exploratory laparotomy. Conclusions The analysis of previously reported cases adds to the limited literature on broad ligament hernias and highlights the surgical management of this uncommon pathology. It also highlights the need for a broad differential diagnosis when female patients present with pelvic pain or symptoms of small bowel obstruction. The broad ligament should be fully inspected when mesenteric defects are suspected as multiple defects can be present as evidenced by the attached case study.
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Affiliation(s)
- Abin Sajan
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Hazim Hakmi
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Daniel W Griepp
- College of Medicine, New York Institute of Technology, Old Westbury, NY
| | - Amir H Sohail
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Helen Liu
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - David Halpern
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
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Kelahan L, Menias CO, Chow L. A review of internal hernias related to congenital peritoneal fossae and apertures. Abdom Radiol (NY) 2021; 46:1825-1836. [PMID: 33128101 DOI: 10.1007/s00261-020-02829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023]
Abstract
Congenital-type internal hernias have the potential to cause small bowel obstruction well into adulthood. Congenital-type internal hernias include left paraduodenal, right paraduodenal, foramen of Winslow, pericecal, sigmoid mesocolon, transomental, small bowel mesentery, and broad ligament hernias. This review summarizes CT imaging features and complications of congenital internal hernias using a systematic approach based on abdominopelvic quadrants and key anatomic features. CT imaging will continue to be commonly used to evaluate abdominal pain. Anatomical landmarks and characteristic CT findings can help identify congenital internal hernias as a potential cause of abdominal pain.
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Affiliation(s)
- Linda Kelahan
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Lawrence Chow
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
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Broad Band Ligament Hernia Revisited (85 Cases of Allen-Master’s Syndrome; History and Perspectives). CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2019. [DOI: 10.1007/s13669-019-0260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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5
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Internal Hernia through a Defect in the Broad Ligament of Uterus: Laparoscopic Management Using a Self-Anchoring Barbed Suture. ACTA ACUST UNITED AC 2018. [DOI: 10.7602/jmis.2018.21.3.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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6
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Otani-Takei N, Akimoto T, Sadatomo A, Saito O, Muto S, Kusano E, Nagata D. Bowel Obstruction and Peritoneal Dialysis: A Case Report of a Patient with Complications from a Broad Ligament Hernia. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:57-60. [PMID: 27547042 PMCID: PMC4978204 DOI: 10.4137/ccrep.s40059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/23/2016] [Accepted: 06/28/2016] [Indexed: 12/21/2022]
Abstract
Abdominal hernias are a common cause of bowel obstruction. The major types of abdominal hernias are external or abdominal wall hernias, which occur at areas of congenital or acquired weakness in the abdominal wall. An alternative entity is internal hernias, which are characterized by a protrusion of viscera through the peritoneum or mesentery. We herein present the case of a female peritoneal dialysis patient with bowel obstruction due to an internal hernia. Although an initial work-up did not lead to a correct diagnosis, an exploratory laparotomy revealed that she had intestinal herniation due to a defect in the broad ligament of the uterus, which was promptly corrected by surgery. The concerns about the perioperative dialytic management as well as the diagnostic problems regarding the disease that arose in our experience with the present patient are also discussed.
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Affiliation(s)
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine
| | - Ai Sadatomo
- Department of Surgery, Jichi Medical University, Yakushiji, Shimotsuke-Shi, Tochigi, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine
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7
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Reyna-Villasmil E, Prieto Montaño J, Suárez-Torres I, Labarca-Acosta M. [Internal hernia through a broad ligament defect]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 38:583-4. [PMID: 25543860 DOI: 10.1016/j.gastrohep.2014.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/09/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Eduardo Reyna-Villasmil
- Servicio de Obstetricia y Ginecología, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela.
| | - José Prieto Montaño
- Servicio de Cirugía General, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela
| | - Ismael Suárez-Torres
- Servicio de Obstetricia y Ginecología, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela
| | - María Labarca-Acosta
- Servicio de Obstetricia y Ginecología, Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia, Venezuela
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Quiroga S, Sarrias M, Sánchez JL, Rivero J. Small bowel obstruction secondary to internal hernia through a defect of the broad ligament: preoperative multi-detector CT diagnosis. ACTA ACUST UNITED AC 2013; 37:1089-91. [PMID: 22274751 DOI: 10.1007/s00261-012-9846-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of small bowel obstruction secondary to internal hernia through a defect in the broad ligament diagnosed by MDCT and confirmed at surgery. The CT findings that allow the diagnosis of this very rare cause of SBO are presented here.
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Affiliation(s)
- Sergi Quiroga
- Department of Radiology, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, Barcelona, Spain.
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9
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Small bowel obstruction due to broad ligament hernia: computed tomography findings. Hernia 2010; 15:353-5. [DOI: 10.1007/s10029-010-0660-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 03/28/2010] [Indexed: 10/19/2022]
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10
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Demir H, Scoccia B. Internal Herniation of Adnexa Through a Defect of the Broad Ligament: Case Report and Literature Review. J Minim Invasive Gynecol 2010; 17:110-2. [DOI: 10.1016/j.jmig.2009.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 09/26/2009] [Accepted: 10/01/2009] [Indexed: 02/06/2023]
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Yamashiro T, Samura H, Kinjo M, Iida G, Gibo M, Murayama S, Nagahama M, Nishimaki T. CT of internal hernia through a defect of the perirectal fossa. ACTA ACUST UNITED AC 2006; 32:320-2. [PMID: 16944030 DOI: 10.1007/s00261-006-9087-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a case of internal hernia due to a peritoneal defect of the perirectal fossa. This condition is extremely rare and has been reported in the literature only once. This is the first independent case report. CT findings as well as the differential diagnosis of the condition are discussed.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Okinawa, 903-0215, Japan.
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