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At least 19 recordsLinked to original sources
PubMed1996

Two cases of paraduodenal hernia, a rare internal hernia.

Paraduodenal hernia is a rare congenital internal hernia which arises from an error of rotation of the midgut with entrapment of the small intestine beneath the developing colon. It is important as it usually presents as intestinal obstruction, and before laparotomy is often misdiagnosed. Mortality increases significantly with delays in surgical treatment. Two cases are presented: an 8 year old boy and a 52 year old man. Both presented with a short history of abdominal pain and an acute abdomen. With prompt surgical treatment, they recovered rapidly.

Abdominal Pain↗
PubMedDate not supplied

The orientation of the antecolic Roux limb markedly affects the incidence of internal hernias after laparoscopic gastric bypass.

BACKGROUND: Internal herniation of the bowel may be a late complication after the laparoscopic Roux-en-Y gastric bypass (RYGBP). A seemingly minor change in technique is described that significantly prevents herniation behind the Roux limb mesentery. We hypothesized that internal hernias behind the Roux limb mesentery occur more frequently when the Roux limb is oriented such that the distal tip is toward the lesser curvature of the gastric pouch with the bowel then curving to the patient's left, compared with the opposite orientation. METHODS: A retrospective chart review was performed of our prospectively collected database. A change in surgical technique occurred June 2003, in an attempt to reduce internal hernia formation. We compared 200 consecutive antecolic left-oriented RYGBP operations performed immediately previous to June 2003 (Group A) with 200 consecutive antecolic right-oriented RYGBP operations performed after June 2003 (Group B). RESULTS: There was an 9.0% rate of internal hernia formation in Group A (18/200) and a 0.5% rate of internal hernia formation in Group B. Internal hernias were repaired an average of 1.2 years after surgery (range 4-30 months, median 14.3 months). The average length of follow-up was 2.1 and 1.6 years in Groups A and B, respectively. All herniations were behind the Roux limb mesentery. The difference in hernia formation after the change in technique was significant (P<0.005). CONCLUSIONS: With a simple change in technique, the incidence of internal herniation behind the Roux limb mesentery may be significantly reduced or eliminated.

Gastric Bypass↗
PubMed2006

Review of internal hernias: radiographic and clinical findings.

OBJECTIVE: Internal hernias, including paraduodenal (traditionally the most common), pericecal, foramen of Winslow, and intersigmoid hernias, account for approximately 0.5-5.8% of all cases of intestinal obstruction and are associated with a high mortality rate, exceeding 50% in some series. To complicate matters, the incidence of internal hernias is increasing because of a number of relatively new surgical procedures now being performed, including liver transplantation and gastric bypass surgery. A significant increase in hernias is occurring in patients undergoing transmesenteric, transmesocolic, and retroanastomotic surgical procedures. It is important for radiologists to be familiar with and to understand the various types of internal hernias and their imaging features so that prompt and accurate diagnosis of these conditions can be made. CONCLUSION: This article illustrates the imaging findings of internal hernias, with emphasis placed on the CT findings, especially in transmesenteric, transmesocolic, and retroanastomotic types of internal hernias.

Hernia, Abdominal↗
PubMed1978

"Paratransplant" hernia. Three patients with a new variant of internal hernia.

Three cases of bowel obstruction due to internal hernia caused by entrapment of bowel or omentum through a defect in the peritoneum covering the transplanted kidney are described. All three patients survived due to early surgical intervention and reduction of the hernia and/or resection of necrotic bowel or omentum. In view of the high mortality of peritonitis in transplant patients, early surgical treatment is indicated in all cases of intestinal obstruction to avoid the sequelae of bowel infarction. This "paratransplant" hernia represents the newest type of internal hernia described.

Adult↗
PubMed2005

Radiological diagnosis of internal hernia after Roux-en-Y gastric bypass.

BACKGROUND: Internal hernia is a known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP). Preoperative diagnosis may be difficult on the basis of history and physical examination. CT scanning is often performed as a diagnostic tool for patients with symptoms after LRYGBP but is often read by the radiologist as non-specific or normal. Preoperative review of the study by the bariatric surgeon who is familiar with the neo-anatomy can identify the internal hernia and its location. METHODS: We retrospectively reviewed our first 185 patients undergoing LRYGBP to identify all patients who developed an internal hernia. The patient's symptoms, physical findings and CT scans were reviewed. Time to presentation with the internal hernia was noted. Radiological interpretation of the scans was recorded, as well as the bariatric surgeon's preoperative impression after review of the scans. RESULTS: In our initial experience of 185 patients undergoing LRYGBP, 5 patients presented at various times in their postoperative course with an internal hernia, for an incidence of 2.7%. All patients underwent preoperative CT scanning. Radiologist interpretation of the scans identified one internal hernia of the 5 preoperatively and was suggestive in another. Preoperative review of the scans by the bariatric surgeon was not only highly suggestive of the diagnosis, but of the location as well, in all 5 cases. CONCLUSION: Preoperative diagnosis of an internal hernia in patients after LRYGBP is often difficult. CT scanning has been found to be a very helpful diagnostic tool, especially when reviewed preoperatively by the bariatric surgeon.

Adult↗
PubMed2006

[Internal hernias--uncommon causes of the status ileosus].

Internal hernia is an uncommon cause of acute intestinal obstruction with. Preoperative diagnosis of an internal hernia is difficult because of the lack of specific signs. Only a few cases of internal hernia have been successfully diagnosed, however, most cases (74%) were initially diagnosed as intestinal obstructions. Authors present the case of the patient with the history of resection of gaster sec. Billroth II with gastroenteroanastomosis. The symptoms of the internal hernia were vomiting, abdominal pain and leaded to an emergency operation. An incarceration of the bowel retroanastomotic under the Braun anastomosis. The obstruction was released by the traction of the bowel and the abnormal opening was sutured to prevent recurrence.

Adult↗
PubMed2002

Internal hernia of the small bowel around infrarenal arterial conduits after liver transplantation.

Internal hernia of the small bowel around infrarenal arterial conduits after liver Internal hernia of the small bowel is an uncommon but fatal complication of liver transplantation. The placement of infrarenal arterial conduits for arterial revascularization is an important technique for arterial reconstruction after liver transplantation. We report three cases of internal hernia with volvulus of the small bowel caused by the use of infrarenal arterial conduits. We reviewed the records of 1066 consecutive patients who underwent orthotopic liver transplantation between June 1994 and April 2000 at the University of Miami. In 271 of these patients, grafts were revascularized by anastomosing the donor iliac artery to the infrarenal aorta (an infrarenal arterial conduit). Two patients died after the surgery. One patient died of multiple organ failure because of sepsis 1 month after the surgery that involved reduction of the internal hernia and biliary reconstruction. Another patient died of multiple organ failure because of sepsis 8 days after the surgery that involved reduction of the internal hernia and adhesiolysis. One patient survived after the surgery that involved thrombectomy of the arterial graft and reduction of the internal hernia. Although there was ischemic damage to the liver after the surgery, the patient recovered. However, he died of liver failure because of recurrent infection with the hepatitis C virus 18 months after the surgery. Transplant surgeons should be aware that this complication causes not only bowel obstruction but also hepatic arterial thrombosis and ischemic liver damage. In order to prevent this complication, the arterial conduit should be retroperitonealized at the time of transplantation.

Adult↗
PubMed2002

Internal hernia: an increasingly common cause of small bowel obstruction.

Internal hernia is an uncommon cause of small bowel obstruction that may be increasing in frequency. Because the clinical diagnosis of internal hernia is difficult, imaging studies such as computed tomography (CT) and small bowel follow through play an important role. Transmesenteric hernia is the most common type and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis (eg, liver transplantation, gastric bypass). CT may allow confident diagnosis in most cases. In this article, we review the clinical and imaging findings of internal hernia based on our experience with 54 cases of surgically proven internal hernias including 45 transmesenteric, 6 paraduodenal, and 3 omental hernias, 39 of which had imaging studies available for review.

Hernia↗
PubMedDate not supplied

CT of internal hernias.

Computed tomography (CT) plays an important role in diagnosis of acute intestinal obstruction and planning of surgical treatment. Although internal hernias are uncommon, they may be included in the differential diagnosis in cases of intestinal obstruction, especially in the absence of a history of abdominal surgery or trauma. CT findings of internal hernias include evidence of small bowel obstruction (SBO); the most common manifestation of internal hernias is strangulating SBO, which occurs after closed-loop obstruction. Therefore, in patients suspected to have internal hernias, early surgical intervention may be indicated to reduce the high morbidity and mortality rates. In a study of 13 cases of internal hernias, nine different types of internal hernias were found and the surgical and radiologic findings were correlated. The following factors may be helpful in preoperative diagnosis of internal hernias with CT: (a) knowledge of the normal anatomy of the peritoneal cavity and the characteristic anatomic location of each type of internal hernia; (b) observation of a saclike mass or cluster of dilated small bowel loops at an abnormal anatomic location in the presence of SBO; and (c) observation of an engorged, stretched, and displaced mesenteric vascular pedicle and of converging vessels at the hernial orifice.

Adolescent↗
PubMed1993

[A rare form of internal hernia: hernia of the sigmoid mesocolon].

An internal hernia of sigmoid mesocolon provoking an occlusive syndrome is described, and the different types of hernia of sigmoid mesocolon analyzed and discussed. The diagnosis of these rare (5% of cases) internal hernias is established frequently at operation only, their treatment, always surgical, being simple when instituted in their early stages.

Hernia↗
PubMed2004

Internal hernias after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic gastric bypass (Lap-RYGB) is an increasingly common procedure performed for severe obesity. Internal hernias are a potential problem associated with Lap-RYGB, and little is known about the clinical presentation and the diagnostic accuracy of this potentially serious complication. METHODS: A retrospective review of 1,000 retrocolic Lap-RYGB was performed to identify those who developed postoperative internal hernias. Clinical symptoms, radiologic characteristics, and operative outcomes were analyzed to determine clinical and radiologic diagnostic accuracy (including computed tomography [CT] scan and upper gastrointestinal imaging). Subsequent independent review was performed to match operative intervention with radiologic imaging and interpretation. Operative outcomes, including the hernia closure technique, hospital length of stay, and mortality were obtained. RESULTS: Of 1,000 Lap-RYGB procedures, 45 internal hernias were identified (4.5%) in 43 patients. Hernia location included transverse colon mesentery (n = 43, 95%) or Petersen's defect (n = 2, 5%). The most common clinical symptoms included intermittent, postprandial abdominal pain, and/or nausea vomiting (86%), although 20% had no abdominal tenderness. Initial radiologic imaging studies were diagnostic in 64%, although subsequent review of all imaging studies showed diagnostic abnormalities in 97%. CT findings suggestive of internal hernia include small bowel loops in the left upper quadrant and evidence of small bowel mesentery traversing the transverse colon mesentery. All patients with internal hernias underwent operative repair (98% performed laparoscopic). One patient had a negative laparoscopy, although the preoperative CT suggested an internal hernia was present. The mean time to intervention for an internal hernia repair was 225 days (range 2 to 490), whereas hospital length of stay was 1.2 days (range 1 to 4). No deaths were noted. CONCLUSIONS: Internal hernias after retrocolic lap-RYGB are associated with vague abdominal complaints and limited radiologic imaging results. A high index of clinical suspicion should be used in this patient population, and surgeon review of radiology imaging studies should be performed. Prompt surgical intervention is successful and can commonly be performed laparoscopically.

Adult↗
PubMed1994

[Laparoscopic therapy for internal hernias. Presentation of three cases].

Internal abdominal hernias are rare and often are first seen when causing ileus. Three different internal hernias were operated on laparoscopically: a patient with a hernia duodeno-jejunalis causing recurrent pain in the upper bowel, vomitus and ileus; two patients with an intersigmoidal hernia and pelvic hernia causing ileus without prodroma. Each case was operated on laparoscopically during or short after ileus. In all cases the hernia could be assured and treated by retracting the gut into the abdominal cavity and either wide opening of the hernia's entrance or closing it by suture. It is concluded that internal hernias can be diagnosed and treated laparoscopically as well as in conventional operation techniques.

Abdominal Pain↗