Clinical spectrum of internal hernia: A surgical emergency
- 302 Downloads
To define the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center.
We reviewed the medical records, imaging studies, and operative findings of 20 patients who underwent surgery for an internal hernia at our medical center between 1995 and 2005. The clinical characteristics and related indicators of the patients with, and those without bowel ischemia were compared and analyzed statistically.
The subtypes of congenital internal hernia (CIH) included transmesenteric (n = 6, 60%), paraduodenal (n = 2, 20%), and pericecal (n = 2, 20%) hernia. The abdominal surgical procedures preceding acquired internal hernia (AIH) were Roux-en-Y anastomosis (n = 6, 60%) and appendectomy (n = 3, 30%). Transmesenteric hernia was the most prevalent type of CIH in children. Abdominal rebound tenderness, advanced leukocytosis (>18 000/mm3), or a high level of manual band form (>6%) were the positive predictive factors for bowel ischemia, whereas a history of chronic intermittent abdominal pain was a negative indicator. No recurrence was noted during the 10-year study period. The overall mortality rate was 20%, attributable to enteral bacteria sepsis in all cases.
Internal hernia is a rare but lethal condition. Early diagnosis and prompt surgical intervention provide the only chance of a successful outcome.
Key wordsInternal hernia Small-bowel obstruction Indicator Bowel ischemia
- 10.Carlisle BB, Killen DA. Spontaneous transverse mesocolic hernia with re-entry into the greater peritoneal cavity: report of a case with review of the literature. Surgery 1967;62:268–273.Google Scholar
- 12.Lefall LD, Quander J, Syphax B. Strangulation intestinal obstruction. Arch Surg 1965;9:592–596.Google Scholar
- 31.Callander LC, Rusy GY, Nemir A. Mechanisms, symptoms and treatment of hernia into the descending mesocolon: Left duodenal hernia. Surg Gynecol Obstet 1935;60:1052–1071.Google Scholar
- 35.Hansmann GH, Morton SA. Intra-abdominal hernia: report of a case and review of the literature. Arch Surg 1939;39:973–986.Google Scholar
- 37.Mock CJ, Mock HE Jr. Strangulated internal hernia associated with trauma. Arch Surg 1958;77:881–886.Google Scholar