Intramesosigmoid hernia: preoperative diagnostic MDCT findings

Laparoscopic treatment of small bowel strangulation caused by an intramesosigmoid hernia and review of literature

An internal hernia is defined as a protrusion of an abdominal viscera through the defects of the gastrointestinal mesentery or peritoneum-lined fossa. Sigmoid mesocolic hernias are an uncommon type of internal hernias, accounting for only 6% of all internal hernias. Furthermore, intramesosigmoid hernia is one of the three subtypes of the sigmoid mesocolic hernias. Internal hernias are potentially fatal conditions with diagnostic challenges. Patients presenting with acute obstruction, no surgical history and no external hernia should receive an urgent CT scan to facilitate early surgery and to minimise the risk of strangulation and bowel resection. Here, we report a case of strangulated small bowel obstruction secondary to an intramesosigmoid hernia with a successful laparoscopic repair. We also present a literature review of all reported cases so far and give an up-to-date perspective on intramesosigmoid hernia.

Emergency laparoscopic approach without sufficient preoperative decompression for intersigmoid hernia: A case report

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Emergency laparoscopy can be performed without sufficient small bowel decompression.

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MDCT is advantageous for preoperatively recognizing anatomical relationships.

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Careful preoperative diagnosis and emergency laparoscopy can lead to good outcomes.

Introduction

In acute care surgery, an increasing number of patients operatively treated for small bowel obstruction undergo laparoscopic procedures. However, intersigmoid hernia is a rare condition. In some reports, surgeons have successfully operated on patients with an intersigmoid hernia via a laparoscopic approach. The laparoscopic approach has the advantage of facilitating simultaneous diagnosis and surgical intervention for intersigmoid hernias. In the laparoscopic approach, sufficient decompression of the small bowel is preoperatively performed in most cases.

Presentation of case

We encountered a patient with an intersigmoid hernia who underwent an emergency laparoscopic approach without sufficient decompression. Because sufficient decompression of the small bowel was not preoperatively performed, it was difficult to establish a working space and visualize the site of obstruction; however, we performed the laparoscopic approach safely, and diagnosis and surgical intervention were possible. Moreover, the postoperative course was uneventful.

Discussion

We successfully performed an emergency surgery using a laparoscopic approach for an intersigmoid hernia without sufficient decompression. The success of the procedure is attributable to the disease-specific surgical strategy, surgical technique, and the recent technological advances in multidetector-row computed tomography.

Conclusion

We believe that careful preoperative diagnosis and strategy can lead to a good outcome and that the significance of emergency laparoscopic approach without sufficient decompression will keep increasing.

Intramesosigmoid hernia complicated by strangulated small-bowel obstruction

An intramesosigmoid hernia is 1 of the 3 rare types of sigmoid-related hernias that could be complicated by intestinal obstruction. Our patient presented with a clinical picture of intestinal obstruction. CT scan showed features of strangulated small-bowel obstruction secondary to a sigmoid-related hernia. This was confirmed intraoperatively to be an intramesosigmoid hernia. We share the radiological findings with intraoperative surgical correlation and discuss the imaging features described in the literature.

Post-operative transmesosigmoid hernia causing small bowel obstruction: a case report

Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Transmesosigmoid hernia is rare type among others mesosigmoid hernia was rarely reported in the literature. We report the case of a 44-year-old male who presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiography examination were suggested intestinal obstruction due to postoperative adhesion. The diagnosis of small bowel obstruction due to internal hernia was confirmed by laparotomy exploration. The herniated loop was reduced successfully and the defect was approximated with interrupted sutures. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This case report highlight difficulty and importance of high index of suspicion considering an internal hernia as a cause of small bowel obstruction in individuals of all age groups with or without a previous history of abdominal surgery.