Internal hernia caused by epiploic appendices successfully treated by single-incision laparoscopic surgery (SILS)

Uncommon presentation of complicated internal hernia through the appendices epiploicae ring of adhesion: a clinical case study

Background

Internal hernias are infrequent, yet serious, medical conditions with potentially severe consequences. An internal hernia resulting from an Appendices epiploicae (AE) ring is an especially rare cause, with a mere nine documented instances worldwide.

Case report

This report presents the case of a 58-year-old male who suffered from an internal hernia originating from an AE ring. The condition led to a gangrenous small bowel, which was treated by laparotomy and resection of the affected segment, followed by primary anastomosis. The post-operative recovery was favorable.

Conclusion

Internal hernias, although rare, warrant immediate attention and early intervention to preclude detrimental outcomes, as illustrated in this particular case.

Two connected large epiploic appendixes make a loop: A case report

Small bowel obstruction (SBO) is a common cause of hospitalization in surgery ward and brings a notable morbidity and mortality with 30,000 annual deaths. In some cases, SBO develops due to the internal hernia. In this case, we present a case of internal hernia in a woman with normal large epiploic appendixes.

An unusual case of intestinal obstruction due to internal herniation from adhesions between two appendices epiploicae

Internal hernia of the small bowel is a rare finding especially in previously non-operated abdomen. Such a hernia occurring due to involvement of appendices epiploicae is an even rare instance with less than five reported cases in the literature. We encountered a 75-year-old male who had internal herniation of small bowel through an aperture created by adhesion between two appendices epiploicae in a previously virgin abdomen. Laparotomy and division of adhesion was performed to manage him successfully. Even in a virgin abdomen, a high index of suspicion along with early intervention is the key to reduction in mortality and morbidity in cases intestinal obstruction.

Single-port surgery (SPS) strategy for small bowel obstruction (SBO) caused by postoperative internal hernia: A series case report

RATIONALE

Internal hernia due to postoperative adhesions sometimes causes small bowel obstruction (SBO) and requires emergency surgery. The difficulties in the management of SBO with internal hernia include accurate diagnosis and estimation of its ischemic degree and of the risk of SBO recurrences following the surgical procedure. Laparoscopic surgery is a noninvasive to reduce postoperative adhesions and therefore has been widely used recently. However, surgeons often tend to hesitate in applying laparoscopic surgery for SBO because of some situational disadvantages such as poor operating space or iatrogenic bowel injury. Hence, laparoscopic surgery is still not yet the standard procedure for SBO caused by internal hernia. Thus, the establishment of an appropriate procedure for SBO due to internal hernia is required.

PATIENT CONCERNS

We experienced 3 SBO cases caused by postoperative internal hernia. The first patient was a 59-year-old man who had temporary loop-ileostomy for a perforated sigmoid colon due to diverticulitis. Severe hypogastralgia and vomiting occurred suddenly on the 33rd postoperative day. The second patient was an 81-year-old man who had been hospitalized due to epigastralgia of unknown origin. He had a surgical history of omentum patching for a perforated duodenum 20 years ago. The third patient was a 72-year-old female who presented at our hospital after sudden and severe hypogastralgia. She had a surgical history of sigmoidectomy for her sigmoid colon cancer 22 years ago.

DIAGNOSIS

A contrast computed tomography (CT) revealed a suspected closed loop obstruction of their bowels and immediate surgical treatments were required.

INTERVENTION

We tried SPS using the surgical glove method as an initial approach for their SBO caused by postoperative internal hernia.

OUTCOMES

Two of these 3 cases completely underwent SPS treatment, which afforded accurate diagnosis of SBO. Laparotomy following SPS, which allowed accurate diagnosis, was judged to be appropriate and was performed in the third case. All the patients were discharged without any complications and SBO have not recurred after their discharge. Finally, we established a new strategy using SPS for SBO with internal hernia.

LESSONS

Our experience suggests that SPS is a promising strategy as an initial surgical approach for SBO with internal hernia.