Intersigmoid Hernia: A Forgotten Diagnosis—A Systematic Review of the Literature over Anatomical, Diagnostic, Surgical, and Medicolegal Aspects

Abstract

Introduction. Intersigmoid hernia is a hernia of the small bowel into the intersigmoid fossa. It is well known to be a rare condition. Recent reports reveal that the preoperative differentiation of intersigmoid hernias is difficult and the diagnosis is often confirmed during the laparotomic exploration. Due to the vague clinical manifestation in most cases, the surgical treatment is frequently delayed. Materials and Methods. In this study, we systematically reviewed the literature up to 2019 covering 114 studies and 124 patients with an intersigmoid hernia. The purpose of this work is to improve the understanding of the anatomical aspects, clinical presentation, diagnosis, and treatment of intersigmoid hernia so as to assist the preoperative differentiation of these hernias when presented as acute abdomen in the emergency department. Results. The diameter of the intersigmoid recess was reported with mean 2.65 cm (range 1–10 cm, SD 1.15 cm) and the length of the incarcerated small intestine was between 3 cm (min) and 150 cm (max): mean 25.25 cm, SD 35.04 cm. The diameter of the sigmoid recess was greater in patients who underwent resection due to strangulation (mean 3.31 cm, SD 1.53 cm) compared to those who underwent only reduction of the hernia (mean 2.35 cm, SD 0.74 cm). The time from onset to operation was less in patients undergoing resection surgery due to throttling (mean 3.03 days, SD 3.01 days) compared to those who underwent only a reduction of hernia incarceration (mean 8.49 days, SD 6.83 days). Conclusion. Intersigmoid hernia is often a forgotten diagnosis and a clinical challange due to its anatomical characteristics.

Intersigmoid Internal Hernia: Laparoscopic Repair of a Rare Cause of Bowel Obstruction

“…Sigmoid mesocolon internal hernias are further divided into intersigmoid, transmesosigmoid, and intramesosigmoid hernias which account for about 6% of internal hernias, and with intersigmoid hernia representing the majority of cases [3]. Intersigmoid hernia (Figure 6) occurs when herniated viscus protrudes through the intersigmoid fossa [4], which is a V-shaped peritoneal recess located at the level of the iliac crest, at the lateral aspect of sigmoid mesocolon with the left ureter lying underneath it [5,6]. This fossa is congenital and is formed when there is a delay or incomplete fusion of the left periotoneal surface of the sigmoid mesentery with the parietal peritoneum of the posterior abdominal wall which normally occurs at 5 months of gestation [3,5].…”

“…CT abdomen is believed to facilitate the diagnosis of internal abdominal hernias [4]. However, surgical intervention is the cornerstone of management in these cases [5]. We present a case of intersigmoid internal hernia that was diagnosed in King Hamad University Hospital with abdominal CT and underwent laparoscopic surgical reduction and dissection of the hernia defect in a 51-year-old Bahraini male.…”

Laparoscopic reduction of intersigmoid hernia: early surgical intervention for a rare form of internal hernia

“…Nowadays, in the era of minimally invasive surgery, laparoscopy might be the initial choice for the surgery of small bowel obstruction. Previous cases on intersigmoid hernia report successful implementation of laparoscopy, which can satisfy both the therapeutic purpose and the diagnostic purpose simultaneously [ 7–9 ]. Decision can be made intraoperatively, depending on the feasibility, whether the operation may be done by laparoscopy or an open conversion may be necessary.…”

A Hospital Protocol for Decision Making in Emergency Admission for Acute Diverticulitis: Initial Results from Small Cohort Series

“…The decision-making process, due to the type of assessment and subsequent therapeutic choices as well as the references to the guidelines above, can also have significant repercussions in the malpractice field [ 44 , 45 ].…”