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Surgery Today

, 38:899 | Cite as

Clinical spectrum of internal hernia: A surgical emergency

  • Hsiu-Ping Fan
  • Albert D. Yang
  • Yu-Jun Chang
  • Chi-Wen Juan
  • Han-Ping Wu
Original Article

Abstract

Purpose

To define the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center.

Methods

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.

Results

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.

Conclusion

Internal hernia is a rare but lethal condition. Early diagnosis and prompt surgical intervention provide the only chance of a successful outcome.

Key words

Internal hernia Small-bowel obstruction Indicator Bowel ischemia 

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Copyright information

© Springer 2008

Authors and Affiliations

  • Hsiu-Ping Fan
    • 1
    • 5
  • Albert D. Yang
    • 2
    • 6
  • Yu-Jun Chang
    • 3
  • Chi-Wen Juan
    • 1
  • Han-Ping Wu
    • 4
    • 7
  1. 1.Department of Emergency MedicineShow Chwan Memorial HospitalChanghuaTaiwan
  2. 2.Department of RadiologyChanghua Christian HospitalChanghuaTaiwan
  3. 3.Laboratory of Epidemiology and BiostatisticsChanghua Christian HospitalChanghuaTaiwan
  4. 4.Department of PediatricsBuddhist Tzu-Chi General HospitalTaichungTaiwan
  5. 5.Institute of Injury Prevention and ControlTaipei Medical UniversityTaipeiTaiwan
  6. 6.Institute of Medical ResearchChang Jung UniversityChanghuaTaiwan
  7. 7.Institute of Clinical MedicineNational Yang-Ming UniversityTaipeiTaiwan

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