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Nesiama EA, Quigley L, Nazim H, Prakash S, Obokhare I. Laparoscopic Repair of Small Bowel Obstruction Caused by an Intersigmoid Hernia: A Case Report. Cureus 2023; 15:e36793. [PMID: 37123668 PMCID: PMC10134408 DOI: 10.7759/cureus.36793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
Bowel obstructions can be caused by internal hernias which are protrusions of the bowel into openings within the abdominal cavity. There are various types of internal hernias including sigmoid hernias which involve the sigmoid mesentery.Sigmoid hernias are very difficult to diagnose clinically, even with the aid of radiologic imaging. Computed tomography (CT) scan findings often reveal small bowel obstructions; however, they are not sensitive to intersigmoid hernias. Most of these rare herniations are repaired by open abdominal surgery followed by the closure of the mesenteric defect to prevent a recurrence. We present the case of a 57-year-old man who presented to the emergency department with a small bowel obstruction that was caused by an intersigmoid hernia and was successfully repaired through a minimally invasive laparoscopic approach. This case demonstrates an intra-operative diagnosis of an intersigmoid hernia and reviews the benefits of a laparoscopic approach for the reduction of the sigmoid mesentery.
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2
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Nakaseko Y, Haruki K, Neki K, Hashizume R, Eto K, Yanaga K. Laparoscopy-Assisted Repair for Intersigmoid Hernia. Case Rep Gastroenterol 2020; 14:675-682. [PMID: 33442348 PMCID: PMC7772840 DOI: 10.1159/000509499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 01/18/2023] Open
Abstract
Intersigmoid hernia is a rare clinical entity. Only 6 cases of laparoscopic repair for intersigmoid hernia have been reported since 1977. We herein report such a case, which was successfully diagnosed preoperatively and treated with laparoscopic repair. A 50-year-old man with a chief complaint of abdominal pain and vomiting was admitted for the treatment of small bowel obstruction. The patient had no history of abdominal surgery. Computed tomography showed a dilated small bowel and a closed loop of small bowel dorsal to the sigmoid colon and the sigmoid mesocolon. With a diagnosis of an incarcerated internal hernia, the patient underwent emergency laparoscopy-assisted surgery. Laparoscopy showed that the ileum had herniated into the intersigmoid fossa, and therefore the patient was diagnosed with an intersigmoid hernia. Because bowel ischemia was not observed, we reduced the incarcerated small bowel, and the hernial defect was widely opened. After operation, the patient developed ileus and was treated with transnasal ileus tube. Thereafter, the patient made a satisfactory recovery and was discharged on postoperative day 21. The patient is in good general condition without ileus 42 months postoperatively.
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Affiliation(s)
- Yuichi Nakaseko
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichiro Haruki
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kai Neki
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Hashizume
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Eto
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Yanaga
- Departments of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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3
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Francis KC, Daley C, Williams BPR, Bullock R, Singh U, Baker A. The "Omega sign": a new radiological sign for a rare type of internal hernia involving the sigmoid mesocolon. BJR Case Rep 2020; 6:20190127. [PMID: 33029380 PMCID: PMC7527005 DOI: 10.1259/bjrcr.20190127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 11/17/2022] Open
Abstract
The transmesosigmoid hernia is a rare type of sigmoid mesocolon hernia. Its presentation is non-specific and thus hardly ever preoperatively diagnosed. Its diagnosis often requires surgical corroboration. This case report aims to improve on the preoperative diagnosis with a proposed observed sign on CT. All literature reviewed described radiological findings related to the small bowel; thus, features of small bowel obstruction was the “hallmark” of internal hernias. This paper intends to describe the features of the sigmoid mesocolon internal hernias, illustrate and propose a never reported configuration of the sigmoid colon. This sigmoid colon configuration has a resemblance to the omega sign. We intend to present a new hallmark sign, which may serve as a clue in the identification of internal hernias involving the sigmoid mesocolon.
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Affiliation(s)
- Kino Ceon Francis
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Candice Daley
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Bonnie-Paul Regis Williams
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Richard Bullock
- Department of Diagnostic and Interventional Radiology, University Hospital of the West Indies, Mona, Jamaica
| | - Ulanda Singh
- Department of Surgery, University Hospital of the West Indies, Mona, Jamaica
| | - Akil Baker
- Department of Surgery, University Hospital of the West Indies, Mona, Jamaica
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Junttila A, Virtanen J, Mrena J, Mattila AK. Laparoscopic treatment of small bowel strangulation caused by an intramesosigmoid hernia and review of literature. BMJ Case Rep 2020; 13:13/4/e233627. [PMID: 32354762 DOI: 10.1136/bcr-2019-233627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Anna Junttila
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Juha Virtanen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Johanna Mrena
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Anne K Mattila
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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Tatsuta K, Miyazaki S, Nishiwaki Y. Emergency laparoscopic approach without sufficient preoperative decompression for intersigmoid hernia: A case report. Int J Surg Case Rep 2019; 64:54-57. [PMID: 31600670 PMCID: PMC6796653 DOI: 10.1016/j.ijscr.2019.09.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
Emergency laparoscopy can be performed without sufficient small bowel decompression. MDCT is advantageous for preoperatively recognizing anatomical relationships. 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.
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Affiliation(s)
- Kyota Tatsuta
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
| | - Shinichiro Miyazaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
| | - Yoshiro Nishiwaki
- Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka, Naka-ku, Shizuoka 432-8580, Japan.
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Sharma K, Dhua A, Thomas D, Sankar MJ. Congenital sigmoid mesocolic defect as a cause of neonatal intestinal obstruction. BMJ Case Rep 2019; 12:12/8/e230253. [PMID: 31466984 DOI: 10.1136/bcr-2019-230253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Internal herniation through congenital sigmoid mesocolic defect as a cause of neonatal intestinal obstruction is rarely reported. Clinical judgement combined with judicious use of investigations and prompt exploration is essential to provide immediate relief of the obstruction and salvage the herniated loop of bowel, which otherwise might lead to morbidity and even death. We present a neonate with internal herniation of the ileum through a congenital mesocolic defect which was diagnosed by a prompt abdominal exploration in view of persistent clinical signs of intestinal obstruction. The relevant literature is also discussed highlighting the rarity of neonatal presentation of sigmoid mesocolic defect.
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Affiliation(s)
- Kanika Sharma
- Pediatric Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Anjan Dhua
- Pediatric Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Deena Thomas
- Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Mari Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
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Nagano H, Goi T, Taguchi S, Tsubaki T, Uematsu H. Diagnosis of incarcerated intramesosigmoid hernia aided by multiplanar reconstruction images of multidetector computed tomography: a case report. Surg Case Rep 2018; 4:128. [PMID: 30343419 PMCID: PMC6195874 DOI: 10.1186/s40792-018-0535-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Internal hernia is a rare cause of intestinal obstruction, and sigmoid mesocolon hernia is an extremely rare form of this condition. Among sigmoid mesocolon hernias, intramesosigmoid hernia is the least frequent subtype. We described a case of intramesosigmoid hernia through the orifice on the right leaf of the mesosigmoid with an incarcerated ileum of 6 cm in length without strangulation. This case was diagnosed by multidetector computed tomography with multiplanar reconstruction images and treated without resection of the small intestine in a 52-year-old man with characteristic diagnostic images. Case presentation A 52-year-old man suffering periumbilical cramping pain with sudden onset that had persisted for 1 week without recovery was referred to Fukui Katsuyama General Hospital. Multidetector computed tomography revealed small bowel obstruction, and an incarcerated short intestinal loop was revealed by sagittal slices of the multiplanar reconstruction images of the routine study of the left side of the pelvic space. Sagittal multiplanar reconstruction images also showed narrow belt-shaped fluid retention contacting the tip of the incarcerated short loop toward the cranial direction localized in the mesosigmoid. These findings indicated that the fluid and the herniated small bowel were wrapped together in the mesosigmoid, which was characteristic of intramesosigmoid hernia. The patient underwent laparotomy operation 2 days after admission. The ileum, which was approximately 75 cm proximal to the ileocecal junction and herniated into the mesosigmoid through the right leaf, was released without resection. The orifice located in the central part of the right leaf was oval shaped and measured less than 2 cm in diameter. The left leaf of the mesosigmoid was intact. The orifice of the right lobe was closed by suture. The patient showed an uneventful recovery. Conclusion We report an extremely rare case of incarcerated intramesosigmoid hernia that was diagnosed by multidetector computed tomography with multiplanar reconstruction images. The finding of narrow belt-shaped fluid retention contacting the tip of the incarcerated short intestinal loop is characteristic of intramesosigmoid hernia and will be useful for conclusively differentiating this disease from transmesosigmoid hernia. Although intramesosigmoid hernia is a rare cause of internal hernia, multidetector computed tomography and multiplanar reconstruction images can provide the characteristic findings and proved useful for the precise preoperative diagnosis and treatment of intramesosigmoid hernia.
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Affiliation(s)
- Hideki Nagano
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan.
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Seiichi Taguchi
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan
| | - Takayoshi Tsubaki
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan
| | - Hidemasa Uematsu
- Department of Radiology, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, 911-8558, Japan
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Hirashima K, Date K, Fujita K, Koide N, Kamuro A, Kato H, Fujita N. Strangulation of the small intestine caused by an intra-mesosigmoid hernia: a case report. Surg Case Rep 2017; 3:129. [PMID: 29270809 PMCID: PMC5740056 DOI: 10.1186/s40792-017-0406-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/07/2017] [Indexed: 11/23/2022] Open
Abstract
Sigmoid mesocolon hernia is an uncommon type of internal hernia with only a few cases reported to date. This disease entity can progress rapidly to cause vascular disturbance, necrosis, and perforation of the bowel wall; therefore, early diagnosis and surgical treatment are essential. We describe the case of an intra-mesosigmoid hernia in a 60-year-old man without history of previous abdominal surgery who presented with sudden acute abdominal pain and vomiting. Based on computed tomography, which showed ascites and small bowel obstruction, we diagnosed him as having strangulation of the small intestine caused by a sigmoid mesocolic hernia and performed emergency surgery. Laparotomy revealed small intestinal strangulation, extensive engorgement, and discoloration of bowel loops. Approximately 100 cm of the small intestine extending from the ligament of Treitz had undergone strangulation and herniated into the defect of sigmoid mesocolon, leading to a diagnosis of an intra-mesosigmoid hernia. Because the incarcerated portion of the small intestine was viable, we did not perform intestinal resection and reconstruction but closed the defect in the sigmoid mesocolon. His postoperative course was uneventful.
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Affiliation(s)
- Kotaro Hirashima
- Department of Surgery, Joetsu General Hospital, 616 Daido-Fukuda, Joetsu City, Niigata, 943-8507, Japan.
| | - Kazutoshi Date
- Department of Surgery, Joetsu General Hospital, 616 Daido-Fukuda, Joetsu City, Niigata, 943-8507, Japan
| | - Kanako Fujita
- Department of Surgery, Joetsu General Hospital, 616 Daido-Fukuda, Joetsu City, Niigata, 943-8507, Japan
| | - Norihiko Koide
- Department of Surgery, Joetsu General Hospital, 616 Daido-Fukuda, Joetsu City, Niigata, 943-8507, Japan
| | - Akihito Kamuro
- Department of Gastroenterology, Joetsu General Hospital, 616 Daido-Fukuda, Joetsu City, Niigata, 943-8507, Japan
| | - Hiroshi Kato
- Department of Radiology, Joetsu General Hospital, 616 Daido-Fukuda, Joetsu City, Niigata, 943-8507, Japan
| | - Nobuhiro Fujita
- Department of Surgery, Joetsu General Hospital, 616 Daido-Fukuda, Joetsu City, Niigata, 943-8507, Japan
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Shibuya N, Ishizuka M, Iwasaki Y, Takagi K, Nagata H, Aoki T, Kubota K. Usefulness of a laparoscopic approach for treatment of small-bowel obstruction due to intersigmoid hernia: a case report. Surg Case Rep 2017; 3:22. [PMID: 28161873 PMCID: PMC5292108 DOI: 10.1186/s40792-017-0298-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
It is well known that intersigmoid hernia (ISH) is a rare condition. Here we describe our experience of laparoscopic surgery for small-bowel obstruction (SBO) due to ISH after sufficient decompression involving long-tube insertion.A 45-year-old woman with no history of abdominal surgery visited our hospital with epigastric pain. She was diagnosed as having SBO and underwent long-tube insertion as conservative therapy. However, her symptoms did not improve. Gastrografin contrast enema via the long-tube demonstrated a beak sign in the lower left abdomen and CT showed incarcerated small bowel was successively covered by sigmoid mesocolon, suggesting that the SBO was due to ISH, and she underwent laparoscopic surgery after sufficient decompression of the dilated small bowel.Intraoperative examination demonstrated incarceration of a loop of the small bowel in the intersigmoid fossa without strangulation. Because the incarcerated portion of the small bowel was not necrotized, herniation repair was performed by removing the incarcerated small bowel from the intersigmoid fossa without closure of the hernia orifice.The postoperative course was uneventful, and the patient is now free of symptoms and recurrence 12 months after surgery. Laparoscopic surgery after sufficient decompression is a useful treatment for SBO due to ISH.
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Affiliation(s)
- Norisuke Shibuya
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Mitsuru Ishizuka
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Yoshimi Iwasaki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Kazutoshi Takagi
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Hitoshi Nagata
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Taku Aoki
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Keiichi Kubota
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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10
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Kumagai K, Yoshioka M, Iida M, Kudoh K, Uchinami H, Watanabe T, Yamamoto Y. Usefulness of Oblique Multiplanar Images on Multi-Detector Computed Tomography for Diagnosing Intersigmoid Hernia. Visc Med 2016; 32:437-440. [PMID: 28229081 DOI: 10.1159/000450633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intersigmoid hernia is a hernia of the small intestine into the intersigmoid fossa. Because the cavity of the intersigmoid fossa is so small, the preoperative detection of incarcerated intestine and/or mesenteric convergence is very difficult. We report a case of intersigmoid hernia in which the incarcerated bowel and mesenteric convergence could be visualized by oblique multiplanar reconstruction (MPR) images on multi-detector computed tomography (MDCT). CASE REPORT An 82-year-old man with small bowel obstruction was treated conservatively with a long intestinal tube. Axial plane images of MDCT detected only a thickening of the small bowel wall and a narrowing of the lumen in the pelvis. Since a fourteen-day waiting period did not improve the condition at all, he underwent surgery. The small bowel was herniated into the intersigmoid fossa. After surgery, we studied the preoperative images of MDCT once again. However, neither converged mesentery nor hernia orifice had been depicted. We attempted to make oblique coronal/sagittal MPR images using SYNAPSE VINCENT® and succeeded in visualizing not only the incarcerated bowels but also the hernia orifice and mesenteric convergence. CONCLUSION Creating oblique MPR images from the MDCT volume data would help in making a preoperative diagnosis of sigmoid mesocolon hernias such as intersigmoid hernia with increasing confidence.
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Affiliation(s)
- Kenta Kumagai
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Masato Yoshioka
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Masatake Iida
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Kudoh
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Uchinami
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Tasuku Watanabe
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuzo Yamamoto
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Somé OR, Ndoye JM, Yohann R, Nolan G, Roccia H, Dakoure WP, Chaffanjon P. An anatomical study of the intersigmoid fossa and applications for internal hernia surgery. Surg Radiol Anat 2016; 39:243-248. [PMID: 27655149 DOI: 10.1007/s00276-016-1747-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/12/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE To improve the knowledge of the morphometry and the surrounding anatomical structures of the intersigmoid fossa and to determine possible surgical applications. METHOD Forty eight adult cadavers (29 female and 19 male; mean age 83 years) underwent dissection in the Laboratoire d'Anatomie des Alpes Francaises. Two injections in the right carotid resulted in a total body concentration of formalin of 1.3 %. The study parameters were the dimensions of the intersigmoid fossa orifice and the fossa's relationship to surrounding structures. Data were recorded and analyzed using Microsoft Office Excel (MS Cerp). A Pearson coefficient r was used to examine the correlation between the length of colon and the ISF volume. RESULTS The intersigmoid fossa was present in 75 % of cases (n = 36). The average dimensions for the transverse diameter, longitudinal diameter, and the depth were, respectively, 20.5 ± 0.2, 20.3 ± 0.13, and 26.8 ± 0.2 mm. The primary and secondary roots bordering this fossa measured on average 59.1 ± 0.1 and 48.3 ± 0.13 mm. In 13.9 % of cases (n = 5), the maximum depth was >40 mm and in 16.7 % of cases (n = 6), one of the diameters of the orifice entry of the fossa was >40 mm. The ureter and external iliac artery were the most frequently encountered structures during the dissection of the fundus of the intersigmoid fossa. CONCLUSION The intersigmoid fossa remains present in most of the reported dissections of cadavers. It constitutes an essential landmark in the surgery of the sigmoid colon due to its deep structural relationship with the left ureter and external iliac artery.
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Affiliation(s)
- O R Somé
- Laboratoire d'anatomie des Alpes françaises (LADAF) de la faculté de médecine, Université Joseph Fourier, Grenoble, France. .,Laboratoire d'anatomie, Université Cheickh Anta Diop, Dakar, Senegal. .,Institut Supérieur des Sciences de la Santé, Université Polytechnique, Bobo Dioulasso, Burkina Faso.
| | - J M Ndoye
- Laboratoire d'anatomie, Université Cheickh Anta Diop, Dakar, Senegal
| | - R Yohann
- Laboratoire d'anatomie des Alpes françaises (LADAF) de la faculté de médecine, Université Joseph Fourier, Grenoble, France
| | - G Nolan
- Laboratoire d'anatomie des Alpes françaises (LADAF) de la faculté de médecine, Université Joseph Fourier, Grenoble, France
| | - H Roccia
- Laboratoire d'anatomie des Alpes françaises (LADAF) de la faculté de médecine, Université Joseph Fourier, Grenoble, France
| | - W P Dakoure
- Laboratoire d'anatomie des Alpes françaises (LADAF) de la faculté de médecine, Université Joseph Fourier, Grenoble, France
| | - P Chaffanjon
- Laboratoire d'anatomie des Alpes françaises (LADAF) de la faculté de médecine, Université Joseph Fourier, Grenoble, France
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12
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Kheok SW, Haja Mohideen SM, Lim JWM, Santhosh Raj SR. Intramesosigmoid hernia complicated by strangulated small-bowel obstruction. BMJ Case Rep 2016; 2016:bcr-2016-216369. [PMID: 27432828 DOI: 10.1136/bcr-2016-216369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Si Wei Kheok
- Department of Diagnostic Radiology, KK Women's and Children's Hospital, Singhealth Institution, Singapore, Singapore Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | | | - Jason Wei-Min Lim
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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13
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Farah RH, Fahmi Y, Khaiz D, Elhattabi K, Bensardi F, Lefriyekh R, Berrada S, Fadil A, Ouariti NZ. Post-operative transmesosigmoid hernia causing small bowel obstruction: a case report. Pan Afr Med J 2015; 20:318. [PMID: 26175809 PMCID: PMC4491479 DOI: 10.11604/pamj.2015.20.318.5752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/03/2015] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Robleh Hassan Farah
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Yassine Fahmi
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Driss Khaiz
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Khalid Elhattabi
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Fatimazahra Bensardi
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Rachid Lefriyekh
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Saad Berrada
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Abdelaziz Fadil
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Najib Zerouali Ouariti
- Service des Urgences Chirurgicales Viscérales, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
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14
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Abstract
Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Sigmoid mesocolic hernia is an uncommon condition and among others intramesosigmoid hernia was rarely reported in the literature. We report the case of a 49-year-old female with a rare type of congenital internal hernia, through the mesosigmoid, causing small bowel obstruction. She suffered from obstructive symptoms but with no previous history of laparotomy. The diagnosis of internal hernia was suggested by computed tomography, but the type of internal hernia was confirmed by laparoscopic exploration. She underwent laparoscopic detachment of peritoneal attachment comprising hernia sac without defect repair. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This report presents a case of intrasigmoid hernia managed successfully by the laparoscopic approach and shows another surgical technique according to hernia types.
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Affiliation(s)
- Chunseok Yang
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Nam-Gu, Daegu, Republic of Korea
| | - Daedong Kim
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Nam-Gu, Daegu, Republic of Korea
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15
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Jimmy J, Wani SV, Shetty VV, Patankar RV. Laparoscopic management of small bowel obstruction caused by a Sigmoid Mesocolic hernia. J Minim Access Surg 2013; 7:236-8. [PMID: 22022113 PMCID: PMC3193694 DOI: 10.4103/0972-9941.85647] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 04/03/2011] [Indexed: 11/04/2022] Open
Abstract
Internal hernias involve protrusion of viscera through the peritoneum or mesentery into a compartment in the abdominal cavity. Hernias occurring through the meso-sigmoid are rare and the most common presentation of this entity is an acute small intestinal obstruction. Pre-operative diagnosis is often difficult and the diagnosis is usually made at surgery. Traditionally, open surgery is used to manage a meso-sigmoid hernia. We report a patient with meso-sigmoid hernia causing intestinal obstruction managed successfully by the laparoscopic approach.
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Affiliation(s)
- John Jimmy
- The Institute for Special Surgery, Joy Hospital, Chembur, Mumbai, India
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16
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Hashimoto D, Hirota M, Sakata K, Yagi Y, Baba H. Adult transmesenteric hernia: report of two cases. Surg Today 2011; 42:489-92. [PMID: 22075661 DOI: 10.1007/s00595-011-0035-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 05/01/2011] [Indexed: 12/21/2022]
Abstract
Transmesenteric hernia is a rare cause of bowel obstruction in adults. We herein describe two cases that occurred in adult women, ages 27 and 19. Both cases presented with abdominal pain without muscular defense signs. Computed tomography of both cases showed features of small bowel obstruction by an internal hernia. A laparotomy showed mesenteric defects of the mesentery of the ileum in the former case and the mesentery of the transverse colon in the latter case, with a herniating ileum. The involved small bowel was viable in both cases, and the bowel was pulled out of the mesenteric defect without resection. The mesenteric defects were then successfully repaired.
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Affiliation(s)
- Daisuke Hashimoto
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
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