Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence

Villalona, Gustavo A.; Diefenbach, Karen A.; Touloukian, Robert J.

doi:10.1016/j.jpedsurg.2009.12.006

Cited by 15 publications

(13 citation statements)

References 8 publications

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“…5,7,[9][10][11]13,15,[17][18][19] Despite the presence of well-reported diagnostic criteria, many nonobstructive IHs go undiagnosed or misdiagnosed. 5,20 It is important to note that these radiographic findings can be subtle, and a lack of awareness likely contributes to missed diagnoses. In a small sample, when radiologists were asked to specifically evaluate for a "sac-like" mass of small bowel, mass effect on the posterior wall of the stomach, and displacement of the IMV, the presence of PDH was able to be identified accurately on CT. 17 In addition, retrospective review of this patient's abdominal CT performed 16 months before diagnosis revealed subtle rostral and leftward displacement of the IMV, engorged mesenteric vessels, and a sac-like mass of small bowel loops.…”

Section: Figurementioning

confidence: 99%

Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

Shi¹,

Felsted²,

Masand³

et al. 2015

Pediatrics

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Paraduodenal hernias are the most common type of congenital internal hernia. Because of its overall rare incidence, this entity is often overlooked during initial assessment of the patient. Lack of specific diagnostic criteria also makes diagnosis exceedingly difficult, and the resulting diagnostic delays can lead to tragic outcomes for patients. Despite these perceived barriers to timely diagnosis, there may be specific radiographic findings that, when combined with the appropriate constellation of clinical symptoms, would aid in diagnosis. This patient first presented at 8 years of age with vague symptoms of postprandial emesis, chronic abdominal pain, nausea, and syncope. Over the span of 6 years he was evaluated 2 to 3 times a year with similar complaints, all of which quickly resolved spontaneously. He underwent multiple laboratory, imaging, and endoscopic studies, which were nondiagnostic. It was not until he developed signs of a high-grade obstruction and extremis that he was found to have a large left paraduodenal hernia that had volvulized around the superior mesenteric axis. This resulted in the loss of the entire superior mesenteric axis distribution of the small and large intestine and necrosis of the duodenum. In cases of chronic intermittent obstruction without clear etiology, careful attention and consideration should be given to the constellation of symptoms, imaging studies, and potential use of diagnostic laparoscopy. Increased vigilance by primary care and consulting physicians is necessary to detect this rare but readily correctable condition.Internal hernias (IHs) are a rare clinical entity that cause 0.6% to 5.8% of small bowel obstructions. 1 There are 2 broad categories of IH: acquired and congenital. These are further categorized by location, which include paraduodenal, transmesenteric, and supra-or perivesical IHs and those located at the Foramen of Winslow. 2,3 Paraduodenal hernias (PDHs) are thought to be the most common type of congenital IH. 2,3 However, with the increasing incidence of procedures that require Roux-en-Y reconstruction, such as gastric bypass surgery, Kasai, choledochal cyst excision, and pediatric liver transplantation, the incidence of acquired IH is increasing. 4 Left PDH refers to a herniation of the small bowel into a mesenteric defect to the left of the inferior mesenteric vein (IMV) with a hernia sac within the leaflets of the left colon mesentery. 5 Symptoms can range from intermittent partial bowel obstruction in cases of spontaneously reducing IH to acute high-grade obstruction that occurs with incarceration or volvulus. 6 Radiographic diagnosis is made difficult because of the often intermittent nature of the disease, in which spontaneous reduction in and resolution of symptoms can occur by the time diagnostic imaging is performed. 2,7 Even when present, Dr Shi drafted the initial manuscript; Ms Felsted assisted in drafting the initial manuscript; Dr Masand provided radiographic expertise, drafted the figure legends, and reviewed and revised the ma...

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Section: Figurementioning

confidence: 99%

Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

Shi¹,

Felsted²,

Masand³

et al. 2015

Pediatrics

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“…[4] Bu tip fıtıklar çocukluk yaşlarında daha çok büyük omentum ve gastrokolik ligamandaki doğumsal defektlerden gelişir. [5] Klinik bulguların karakterini, fıtıklaşan bağırsak segmenti ve defektin çapı belirlemektedir.…”

Section: Discussionunclassified

A rare cause of small intestinal obstruction: Spontaneous strangulated transomental hernia

Ağca

Karıp

İşcan

et al. 2015

Ulus Travma Acil Cerrahi Derg

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ÖZETİnce bağırsak tıkanıklığına neden olabilen internal fıtıklar nadir görülür. Öyküsünde travma ya da cerrahi bir operasyon olmadan da görülebilen transomental fıtıklar daha da nadirdir. Seksen beş yaşında ameliyat ya da travma öyküsü bulunmayan erkek hasta şiddetli karın ağrısı ve kusma nedeniyle acil polikliniğimize başvurdu. Yapılan fiziksel incelemelerde ileus tanısı konularak ameliyata alınan olguda transomental fıtığa bağlı strangülasyona uğramış ileum ansları tespit edildi. Rezeksiyon-anastomoz uygulandı ve omental defekt parsiyel omentektomi ile bozuldu. Transomental fıtıklar çok nadir görülseler de hikayesinde ameliyat ve travma saptanmayan olgularda mekanik bağırsak tıkanıklığı ayırıcı tanısında düşünülmelidir.Anahtar sözcükler: İnce bağırsak tıkanıklığı; internal fıtık; transomental fıtık. GİRİŞİnternal fıtıklara bağlı ince bağırsak tıkanıklıklarının insidansı %0.2-0.9 olarak bildirilmektedir.[1] Karın içerisinde, değişik anatomik bölgelerde oluşabilen internal fıtıklar sıklıkla; paraduodenal (%53), periçekal (%13), foramen Winslow (%8), transmezenterik (%2) ve transomental (%1) alanlarda görülmektedir. [2] Omental hernilerde çok nadir de olsa hastalarda ameliyat veya travma hikayesi yoktur. Omental defektlerin oluşumunda travma, enflamasyon ve yaşa bağlı gelişen atrofiler sorumlu tutulmaktadır. [3] Bu çalışmada hikayesinde ameliyat ve travma hikayesi olmayan, ince bağırsak tıkanıklığı ve nekrozuyla seyreden bir internal omental herni olgusu sunulmuştur. OLGU SUNUMUŞiddetli karın ağrısı, bulantı ve kusma şikâyetleri ile acil polikliniğimize başvuran 85 yaşındaki erkek hastanın son iki gündür OLGU SUNUMU gaz-gaita çıkışı yoktu. Hasta fekaloid karakterde kusmaktaydı. Özgeçmişinde; kalp yetersizliği, hipertansiyon, diabetes mellitus ve kronik obstrüktif akciğer hastalığı (KOAH) olan hasta KOAH nedeniyle bir hafta önce göğüs hastalıkları yoğun bakım ünitesinde yatırılmış ve ev yardımlı mekanik ventilasyon desteğiyle taburcu edilmişti. Yapılan fizik muayenede karında yaygın hassasiyet ve sol üst kadranda ele gelen kitle tespit edildi. Laboratuvar incelemelerinde; lökosit 24.000/mm 3 , hemoglobin 10.4 gr/dl, hemotokrit %31.7, BUN 53 mg/dl, kreatinin 1.65 mg/dl, glukoz 167 mg/dl olarak saptandı. Ayakta direkt batın grafisinde (ADBG) ince bağırsak tipi hava-sıvı seviyeleri saptanan hastanın, intravenöz kontrastlı batın tomografisinde (BT) ise sol üst kadranda mezenteri ile birbiri üzerine dön-müş ince bağırsak segmentleri ve karında yaygın serbest sıvı olduğu izlendi (Şekil 1a-c). Bu bulgularla olgu, akut mekanik bağırsak tıkanıklığı ön tanısı ile ameliyata alındı. Göbek üstü ve kısmi göbek altı orta hat kesiyle batına girildi. Yapılan incelemede batın içerisinde yaygın defibrine kana ve proksimal ince bağırsaklarda dilatasyona ek olarak, ileo-çekal kapağa 10 cm mesafede 50 cm ileum ansının mezenteri ile birlikte sol alt kadranda omental bir pencereden girip torsiyone olduğu ve bu segmentde nekroz oluştuğu tespit edildi (Şekil 2a, b). Makroskopik perforasyon alanı saptanmayan sıkışmış bağırsak ansları omenta...

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“…Patients with a mesenteric defect can present with intestinal obstruction at any age. Most of the documented cases of mesenteric defects as a cause of internal hernia are in the pediatric population, and these cases are speculated to be congenital [8,9]. We herein present two cases of previously asymptomatic 27-and 19-year-old women with mesenteric defects that caused small bowel obstruction by an internal hernia.…”

Section: Introductionmentioning

confidence: 94%

Adult transmesenteric hernia: report of two cases

et al. 2011

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Transmesenteric hernia is a rare cause of bowel obstruction in adults. We herein describe two cases that occurred in adult women, ages 27 and 19. Both cases presented with abdominal pain without muscular defense signs. Computed tomography of both cases showed features of small bowel obstruction by an internal hernia. A laparotomy showed mesenteric defects of the mesentery of the ileum in the former case and the mesentery of the transverse colon in the latter case, with a herniating ileum. The involved small bowel was viable in both cases, and the bowel was pulled out of the mesenteric defect without resection. The mesenteric defects were then successfully repaired.

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Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence

Cited by 15 publications

References 8 publications

Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

Congenital Left Paraduodenal Hernia Causing Chronic Abdominal Pain and Abdominal Catastrophe

A rare cause of small intestinal obstruction: Spontaneous strangulated transomental hernia

Adult transmesenteric hernia: report of two cases

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