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Yokota T, Otani K, Yoshida J, Mochidome N, Miyatake E, Nakahara C, Ishimitsu T, Tanaka M. Paracecal hernia due to membranous adhesion of the omentum to the right paracolic gutter. Surg Case Rep 2019; 5:183. [PMID: 31773456 PMCID: PMC6879700 DOI: 10.1186/s40792-019-0749-8] [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: 07/24/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paracecal hernias, also known as pericecal hernias, are an exceptionally rare type of internal hernia. We report a unique case of paracecal hernia due to membranous adhesion of the omentum to the right paracolic gutter. CASE PRESENTATION An 86-year-old female was admitted to our hospital with vomiting and abdominal pain. Laboratory findings showed a slightly elevated C-reactive protein level. Computed tomography scan showed dilated loops of the small intestine in the right paracolic gutter with medial displacement of the cecum and ascending colon. Internal hernia around the cecum due to postoperative adhesion after appendectomy was suspected, and she underwent emergency laparotomy. Intraoperative findings revealed the adhesion between the omentum and right paracolic gutter forming a cavity with the small intestine incarcerated. No abnormal adhesion in the ileocecal region was seen. We transected the omental adhesion from the orifice to the far end of the cavity near the hepatic flexure of the colon to release strangulation and to prevent recurrence. The patient was discharged on postoperative day 14 without complications. CONCLUSIONS Paracecal hernias have a type of membranous adhesion of the omentum to the right paracolic gutter. Surgeons should be aware of this paracecal hernia type, when they encounter the internal hernia.
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Affiliation(s)
- Taro Yokota
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan
| | - Kazuhiro Otani
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan.
| | - Junichi Yoshida
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan
| | - Naoki Mochidome
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan
| | - Eiji Miyatake
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan
| | - Chihiro Nakahara
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan
| | - Toshiyuki Ishimitsu
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan
| | - Masao Tanaka
- Department of Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki, Yamaguchi, 750-8520, Japan
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Inukai K, Tsuji E, Uehara S. Paracecal hernia with intestinal ischemia treated with laparoscopic assisted surgery. Int J Surg Case Rep 2018; 44:20-23. [PMID: 29462753 PMCID: PMC5832674 DOI: 10.1016/j.ijscr.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/18/2018] [Accepted: 02/11/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Paracecal hernia is rare, and strangulation with ischemia has been infrequently observed in the limited number of published reports on paracecal hernias. PRESENTATION OF CASE We describe a case of an incarcerated paracecal hernia with resultant ischemic bowel that was successfully treated with laparoscopic-assisted surgery. A 54-year-old man who had not undergone any surgery previously presented to our hospital with abdominal pain and vomiting. An abdominal computed tomographic scan showed evidence of an intestinal obstruction at a paracecal site. An emergency laparoscopic surgery demonstrated incarceration of a loop of the small bowel in the paracecal fossa. We removed the incarcerated small bowel from the paracecal fossa, noted that the tissue was necrotic, and resected this segment of bowel through a mini-laparotomy incision. The patient was discharged on the 13th postoperative day. DISCUSSION AND CONCLUSION This case is unique in that the patient presented with small bowel strangulation, causing intestinal ischemia. Laparoscopic surgery is useful in the diagnosis of internal hernias and is also useful for the treatment of small bowel obstruction due to paracecal hernias complicated by ischemic bowel.
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Affiliation(s)
- Koichi Inukai
- Department of Surgery, Kariya Toyota General Hospital, Aichi, Japan.
| | - Eri Tsuji
- Department of Surgery, Kariya Toyota General Hospital, Aichi, Japan
| | - Shuhei Uehara
- Department of Surgery, Kariya Toyota General Hospital, Aichi, Japan
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