Internal Hernias Involving the Sigmoid Mesocolon

Article · April 1964with155 Reads
DOI: 10.1097/00000658-196403000-00008 · Source: PubMed
    • Intramesosigmoid hernia is the rarest of these three and is herniation of the bowel through an isolated oval defect, which may be situated in the sigmoid mesentery either on the medial aspect or lateral aspect adjacent to the sigmoid colon involving only one leaf of the sigmoid mesentery [5]. Benson and Killen were the first to report the rarest variety intramesosigmoid hernia in 1964 [3]. An extensive review of English and Japanese literature revealed that barely more than 50 cases of intramesosigmoid hernias have been reported since 1964 [6,7] .
    [Show abstract] [Hide abstract] ABSTRACT: Internal hernia, as the cause of acute intestinal obstruction, is rare and sigmoid hernia is not one of the most common internal hernias. Moreover, intramesosigmod hernias are of the rarest variety. Establishing precise preoperative clinical diagnosis is a challenge for a surgeon. Strangulated sigmoid hernia has high morbidity and mortality. Prompt exploration has to be undertaken based on clinical signs and symptoms rather than searching for the exact cause of obstruction. Here, an extremely rare case of intramesosigmoid hernia is presented with a defect in the medial leaf of the mesentery leading to small bowel obstruction.
    Full-text · Article · Sep 2015
    • Although the intersigmoid fossa is found in 65% of all autopsies [2], sigmoid mesocolon hernias account for only 6% of all internal hernias [1]. Benson and Killen [3] classified sigmoid mesocolon hernias as intersigmoid hernias, transmesosigmoid hernias, and intramesosigmoid hernias. While the current report involved a case of single-incision laparoscopic surgery for an intersigmoid hernia, a total of 62 cases of internal hernia involving the mesosigmoid have been reported in Japan from 2000 to 2013.
    [Show abstract] [Hide abstract] ABSTRACT: Intersigmoid hernia is a rare form of internal hernia. Here, we report a case of intersigmoid hernia and provide a brief review of the 62 cases involving the mesosigmoid reported in Japan from 2000 to 2013. In the current case, a 26-year-old man with no previous history of abdominal surgery presented with abdominal pain and vomiting. Abdominal computed tomography revealed an extensively dilated small bowel and a closed loop of small bowel in the mesosigmoid. The patient was diagnosed with an intestinal obstruction due to an incarcerated internal hernia involving the mesosigmoid. There was no blood flow obstruction at the incarcerated bowel. An elective single-incision laparoscopic surgery was performed after decompression of the bowel using ileus tube. As the ileum herniated into the intersigmoid fossa, the patient was diagnosed with an intersigmoid hernia. The incarcerated small bowel was reduced in order to make it viable, and the hernial defect was closed with interrupted sutures. The patient had an uneventful recovery and was discharged on postoperative day five.
    Full-text · Article · Nov 2014
    • Sigmoid mesocolic hernia although uncommon, it is not extremely rare accounting for 5% of all internal hernias [8]. Benson and Killen [9] classified sigmoid mesocolic hernias into the following three types. (i) intersigmoid hernia: herniation into an intersigmoid fossa, situated at the attachment of the lateral aspect of the sigmoid mesocolon.
    [Show abstract] [Hide abstract] ABSTRACT: Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Sigmoid mesocolic hernia is an uncommon condition and among others intramesosigmoid hernia was rarely reported in the literature. We report the case of a 49-year-old female with a rare type of congenital internal hernia, through the mesosigmoid, causing small bowel obstruction. She suffered from obstructive symptoms but with no previous history of laparotomy. The diagnosis of internal hernia was suggested by computed tomography, but the type of internal hernia was confirmed by laparoscopic exploration. She underwent laparoscopic detachment of peritoneal attachment comprising hernia sac without defect repair. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This report presents a case of intrasigmoid hernia managed successfully by the laparoscopic approach and shows another surgical technique according to hernia types.
    Full-text · Article · May 2014
    • The herniated small-bowel loops may become trapped and there is usually mass effects causing displacement of the posterior wall of the stomach, duodenojejunal flexure and transverse colon. Benson and Killen [12] classified sigmoid mesocolon hernias into the following three types: intersigmoid hernia (herniation into an intersigmoid fossa, situated at the attachment of the lateral aspect of the sigmoid mesocolon); transmesosigmoid hernia (incarceration of intestinal loops through an isolated, oval defect in the sigmoid mesocolon . No hernia sac is present); intramesosigmoid hernia (a congenital, oval defect unrelated to the intersigmoid fossa is present in the lateral peritoneal surface of the mesocolon, and herniation occurs.
    [Show abstract] [Hide abstract] ABSTRACT: Introduction Intestinal obstruction by congenital internal hernia is rare and unsuspected. Case report We report the case of a 45 years-old-man diagnosed to have an intestinal obstruction caused by a double concomitant internal hernia. CT scan can provide a fast diagnosis in order not to delay the surgical intervention: the ileum had been entrapped into a big internal hernia between the transverse and the descending colon and the patient was diagnosed to have a paraduodenal hernia. During the intervention a concomitant mesosigmoid defect was found. Results Our patient had a left paraduodenal hernia with much of the small bowel crowned into a round peritoneal membrane just in front and left to the duodenum and pancreas and between the transverse and descending colon. CT scan showed encapsulated cluster of small bowel loops in the hernia sac. He was taken up for surgery and an urgent laparoscopic access was performed for definitive diagnosis and treatment 4 days after the beginning of the symptoms. Conclusions Congenital Internal Hernia should be considered as a cause of bowel obstruction in absence of previous abdominal surgery and, even if preoperative diagnosis of a paraduodenal hernia is difficult, it must be considered as part of differential diagnosis.
    Full-text · Article · Feb 2013
    • Although transmesenteric hernias are increasing in incidence, transmesosigmoid herniation is very rare, especially in patients with no previous history of abdominal surgery or trauma. Congenital internal hernias of the sigmoid mesentery are divided into three categories: intersigmoid, intramesosigmoid and transmesosigmoid [5] . Transmesosigmoid hernias occur when a loop of small bowel passes through a defect in the sigmoid mesentery.
    [Show abstract] [Hide abstract] ABSTRACT: Internal hernias are a rare cause of small bowel obstruction and are estimated to account for 1% to 5% of cases. Herniation through a defect in the sigmoid mesocolon constitutes 6% of all internal hernias. In this case report we describe a rare case of a fit and healthy 60-year-old man, with no previous history of abdominal surgery, who presented with signs and symptoms of small bowel obstruction as a result of an incarcerated transmesosigmoid hernia. The hernia was reduced and the incarcerated loop of small bowel was found to be viable. The patient made a good recovery and was discharged home on the fourth post-operative day. Internal hernias can cause considerable morbidity and mortality, so prompt diagnosis is paramount. Transmesosigmoid hernias are most common in the paediatric population; however, our patient was 60 years old. This report highlights the importance of considering an internal hernia as a cause of small bowel obstruction in individuals of all age groups and especially in those without a previous history of abdominal surgery.
    Full-text · Article · Feb 2008
    • Transmesosigmoid hernia is incarceration of small bowel loops through a defect in the sigmoid mesocolon. This defect is oval and ranges in diameter from 2 to 4 cm (1,3,45,46). Transmesosigmoid hernia involves both layers of the sigmoid mesentery and allows herniation of the small bowel loops toward the left lower abdomen , posterior-lateral to the sigmoid colon.
    [Show abstract] [Hide abstract] ABSTRACT: 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.
    Article · Jul 2005
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