Skip to main content

Advertisement

SpringerLink
Log in

Clinical spectrum of internal hernia: A surgical emergency

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blachar A, Federle MP. Internal hernia: an increasingly common cause of small bowel obstruction. Semin Ultrasound CT MR 2002;23:174–183.

    Article  PubMed  Google Scholar 

  2. Khan MA, Lo AY, Vande Maele DM. Paraduodenal hernia. Am Surg 1998;64:1218–22.

    PubMed  CAS  Google Scholar 

  3. Sasaki T, Sakai K, Fukumori D, Sato M, Ohmori H, Yamamoto F. Transmesosigmoid hernia: report of a case. Surg Today 2002;32:1096–1098.

    Article  PubMed  Google Scholar 

  4. Ghahremani GG. Internal abdominal hernias. Surg Clin North Am 1984;64:393–406.

    PubMed  CAS  Google Scholar 

  5. Janin Y, Stone AM, Wise L. Mesenteric hernia. Surg Gynecol Obstet 1980;150:747–754.

    PubMed  CAS  Google Scholar 

  6. Rivkind AI, Shiloni E, Muggia-Sullam M, Weiss Y, Lax E, Freund HR. Paracecal hernia: a cause of intestinal obstruction. Dis Colon Rectum 1986;29:752–754.

    Article  PubMed  CAS  Google Scholar 

  7. Blachar A, Federle MP, Brancatelli G, Peterson MS, Oliver JH 3rd, Li W. Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology 2001;221:422–428.

    Article  PubMed  CAS  Google Scholar 

  8. Fujiwara T, Ohno Y, Sasaki A, Suzaki N, Matsuo Y. Internal hernia with triple hiatus of congenital origin: report of a case. Surg Today 2000;30:954–958.

    Article  PubMed  CAS  Google Scholar 

  9. Meyers MA. Paraduodenal hernias. Radiologic and arteriographic diagnosis. Radiology 1970;95:29–37.

    PubMed  CAS  Google Scholar 

  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 

  11. Liakakos T, Liatas AC, Kakoulides D, Dendrinos S. Multiple congenital internal hernias as a cause of acute abdominal symptoms in late adult life. Eur J Surg 1992;158:561–562.

    PubMed  CAS  Google Scholar 

  12. Lefall LD, Quander J, Syphax B. Strangulation intestinal obstruction. Arch Surg 1965;9:592–596.

    Google Scholar 

  13. Bizer LS, Liebling RW, Delany HM, Gliedman ML. Small bowel obstruction. Surgery 1981;89:407–413.

    PubMed  CAS  Google Scholar 

  14. Shatila AH, Chamberlain BE, Webb WR. Current status of diagnosis and management of strangulation obstruction of the small bowel. Am J Surg 1976;132:299–303.

    Article  PubMed  CAS  Google Scholar 

  15. Shannon R. Strangulating intestinal obstruction: a review of 115 cases. Aust N Z J Surg 1968;38:21–23.

    PubMed  CAS  Google Scholar 

  16. Pal JC, Das D. Strangulated intestinal obstruction. J Indian Med Assoc 1980;74:109–111.

    PubMed  CAS  Google Scholar 

  17. Takayama S, Hirokawa T, Sakamoto M, Takahashi H, Yamamoto M, Sato M, Manabe T. Laparoscopic management of small bowel incarceration caused by a broad ligament defect: report of a case. Surg Today 2007;37:437–439.

    Article  PubMed  Google Scholar 

  18. Newson BD, Kukora JS. Congenital and acquired internal hernias: Unusual causes of small bowel obstruction. Am J Surg 1986;152:279–285.

    Article  Google Scholar 

  19. Bolin TE. Internal herniation through the broad ligament. Case report. Acta Chir Scand 1987;153:691–693.

    PubMed  CAS  Google Scholar 

  20. Saida Y, Nagao J, Takase M, Noto Y, Kusachi S, Kajiwara Y, et al. Herniation through both Winslow’s foramen and a lesser omental defect: report of a case. Surg Today 2000;30:544–547.

    Article  PubMed  CAS  Google Scholar 

  21. Tsutsui S, Kitamura M, Shirabe K, Tomoda M, Ohmori M, Yoshida M. Lesser sac herniation through the greater omentum and gastro-pancreatic ligament: report of a case. Surg Today 1995;25:59–61.

    Article  PubMed  CAS  Google Scholar 

  22. Cingi A, Demirkalem P, Manukyan MN, Tuney D, Yegen C. Left-sided paraduodenal hernia: report of a case. Surg Today 2006;36:651–654.

    Article  PubMed  Google Scholar 

  23. McDonagh T, Jelinek GA. Two cases of paraduodenal hernia, a rare internal hernia. J Accid Emerg Med 1996;13:64–68.

    PubMed  CAS  Google Scholar 

  24. Wojtasek DA, Codner MA, Nowak EJ. CT diagnosis of cecal herniation through the foramen of Winslow. Gastrointest Radiol 1991;16:77–79.

    Article  PubMed  CAS  Google Scholar 

  25. Hosono S, Ohtani H, Arimoto Y, Kanamiya Y. Internal hernia with strangulation through a mesenteric defect after laparoscopy-assisted transverse colectomy: report of a case. Surg Today 2007;37:330–334.

    Article  PubMed  Google Scholar 

  26. Khanna A, Newman B, Reyes J, Fung JJ, Todo S, Starzl TE. Internal hernia and volvulus of the small bowel following liver transplantation. Transpl Int 1997;10:133–136.

    Article  PubMed  CAS  Google Scholar 

  27. Blachar A, Federle MP. Bowel obstruction following liver transplantation: clinical and CT findings in 48 cases with emphasis on internal hernia. Radiology 2001;218:384–388.

    PubMed  CAS  Google Scholar 

  28. Sabesta DG, Robson MC. Petersen’s retroanastomotic hernia. Am J Surg 1968;116:450–453.

    Article  Google Scholar 

  29. Murphy DA. Internal hernias in infancy and childhood. Surgery 1964;55:311–316.

    PubMed  CAS  Google Scholar 

  30. Brigham RA, Fallon WF, Saunders JR, Harmon JW, d’Avis JC. Paraduodenal hernia: diagnosis and management. Surgery 1984;96:498–502.

    PubMed  CAS  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 

  32. Berardi RS. Paraduodenal hernias. Surg Gynecol Obstet 1981;152:99–110.

    PubMed  CAS  Google Scholar 

  33. Freund H, Berlatzky Y. Small paraduodenal hernias. Arch Surg 1977;112:1180–1183.

    PubMed  CAS  Google Scholar 

  34. Blachar A, Federle MP, Dodson SF. Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology 2001;218:68–74.

    PubMed  CAS  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 

  36. Nathan H. Internal hernia. J Int Coll Surg 1960;34:563–571.

    PubMed  CAS  Google Scholar 

  37. Mock CJ, Mock HE Jr. Strangulated internal hernia associated with trauma. Arch Surg 1958;77:881–886.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan

    Hsiu-Ping Fan & Chi-Wen Juan

  2. Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan

    Albert D. Yang

  3. Laboratory of Epidemiology and Biostatistics, Changhua Christian Hospital, Changhua, Taiwan

    Yu-Jun Chang

  4. Department of Pediatrics, Buddhist Tzu-Chi General Hospital, Taichung Branch, No. 66, Sec. 1, Fongsing Road, Tanzih, Taichung, 42743, Taiwan

    Han-Ping Wu

  5. Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan

    Hsiu-Ping Fan

  6. Institute of Medical Research, Chang Jung University, Changhua, Taiwan

    Albert D. Yang

  7. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Han-Ping Wu

Authors
  1. Hsiu-Ping Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Albert D. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-Jun Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chi-Wen Juan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Han-Ping Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fan, HP., Yang, A.D., Chang, YJ. et al. Clinical spectrum of internal hernia: A surgical emergency. Surg Today 38, 899–904 (2008). https://doi.org/10.1007/s00595-007-3756-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-007-3756-5

Key words

Search

Navigation