<strong>Introduction:</strong> <span style="font-family:""><span style="font-family:Verdana;">The left mesenterico-parietal hernia or left paraduodenal hernia is an ano...<strong>Introduction:</strong> <span style="font-family:""><span style="font-family:Verdana;">The left mesenterico-parietal hernia or left paraduodenal hernia is an anomaly of intestinal rotation which may be responsible for intestinal obstruction. It is rare. </span><b><span style="font-family:Verdana;">Observation: </span></b><span style="font-family:Verdana;">A 5-year-old boy was admitted for abdominal pain with episodes of vomiting and cessation of matters and gases. After clinical and paraclinical investigations, the diagnosis of occlusion was accepted and the child was operated. Exploration revealed a mesenterico-parietal hernia with a retrocolic sac measuring 11 cm of collar and a deep of 18 cm containing a twisted bowel. After reduction of the content, we untwisted the small intestine and released adhesions. The hernial sac was partially resected and the defect was closed. Operating outcomes were simple. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The mesenterico-parietal hernia is a cause of organic intestinal obstruction. Although of congenital origin, it can have a late clinical manifestation. It should be considered in case of episodes of repetitive abdominal pain and vomiting to avoid complications.</span></span>展开更多
BACKGROUND:Emergency physicians(EPs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determ...BACKGROUND:Emergency physicians(EPs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determine features that predict the need for operative management in emergency department(ED)patients with small bowel obstruction(SBO).METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period.We evaluated demographic characters(prior SBO,prior abdominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative intervention.RESULTS:Patients with a prior SBO were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior SBO[35.2%(57/162)].Abnormal bloodwork was not associated with need for operative intervention.68%of patients with CT scan findings of both an SBO and a hernia,however,were operatively managed.CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization.Abnormal bloodwork was not associated with operative intervention.The CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did not.Further research would be helpful to construct a prediction rule,which could help community EPs determine which patients may benefit from expedited transfer for operative management,and which patients could be safely managed conservatively as an initial treatment strategy.展开更多
Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia...Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia in an elderly person without any preoperative history. An 84-year-old Korean female was admitted with midabdominal pain and distension for 1 d. On abdominal computed tomography, we diagnosed transmesocolic hernia with strangulated small bowel obstruction, and performed emergency surgery. The postoperative period was uneventful and she was discharged 11 d after surgery. Hence, it is important to consider the possibility of transmesocolic hernia in elderly patients with signs and symptoms of intestinal obstruction, even in cases with no previous surgery. 2013 Baishideng. All rights reserved.展开更多
Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-tr...Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.展开更多
We describe a very rare case of an internal hernia associated with a Meckel’s diverticulum, which lead to the death of a young 3 year old boy. The case describes symptoms of abdominal pain and vomiting, on a backgrou...We describe a very rare case of an internal hernia associated with a Meckel’s diverticulum, which lead to the death of a young 3 year old boy. The case describes symptoms of abdominal pain and vomiting, on a background of previous intermittent abdominal pain. The possibility of small bowel obstruction was suspected, and appropriate imaging was performed. This case illustrates the need for a high index of suspicion for small bowel obstruction, with appropriate investigations and review. It also highlights the limitations of imaging modalities in identifying complications of Meckel’s diverticulum. It is important to raise awareness of this fatal cause for small bowel obstruction and to help identify suggestive imaging features, which may point towards a possible complicated Meckel’s diverticulum. Earlier recognition and diagnosis could reduce morbidity and mortality.展开更多
文摘<strong>Introduction:</strong> <span style="font-family:""><span style="font-family:Verdana;">The left mesenterico-parietal hernia or left paraduodenal hernia is an anomaly of intestinal rotation which may be responsible for intestinal obstruction. It is rare. </span><b><span style="font-family:Verdana;">Observation: </span></b><span style="font-family:Verdana;">A 5-year-old boy was admitted for abdominal pain with episodes of vomiting and cessation of matters and gases. After clinical and paraclinical investigations, the diagnosis of occlusion was accepted and the child was operated. Exploration revealed a mesenterico-parietal hernia with a retrocolic sac measuring 11 cm of collar and a deep of 18 cm containing a twisted bowel. After reduction of the content, we untwisted the small intestine and released adhesions. The hernial sac was partially resected and the defect was closed. Operating outcomes were simple. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The mesenterico-parietal hernia is a cause of organic intestinal obstruction. Although of congenital origin, it can have a late clinical manifestation. It should be considered in case of episodes of repetitive abdominal pain and vomiting to avoid complications.</span></span>
文摘BACKGROUND:Emergency physicians(EPs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determine features that predict the need for operative management in emergency department(ED)patients with small bowel obstruction(SBO).METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period.We evaluated demographic characters(prior SBO,prior abdominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative intervention.RESULTS:Patients with a prior SBO were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior SBO[35.2%(57/162)].Abnormal bloodwork was not associated with need for operative intervention.68%of patients with CT scan findings of both an SBO and a hernia,however,were operatively managed.CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization.Abnormal bloodwork was not associated with operative intervention.The CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did not.Further research would be helpful to construct a prediction rule,which could help community EPs determine which patients may benefit from expedited transfer for operative management,and which patients could be safely managed conservatively as an initial treatment strategy.
文摘Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia in an elderly person without any preoperative history. An 84-year-old Korean female was admitted with midabdominal pain and distension for 1 d. On abdominal computed tomography, we diagnosed transmesocolic hernia with strangulated small bowel obstruction, and performed emergency surgery. The postoperative period was uneventful and she was discharged 11 d after surgery. Hence, it is important to consider the possibility of transmesocolic hernia in elderly patients with signs and symptoms of intestinal obstruction, even in cases with no previous surgery. 2013 Baishideng. All rights reserved.
文摘Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography(CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.
文摘We describe a very rare case of an internal hernia associated with a Meckel’s diverticulum, which lead to the death of a young 3 year old boy. The case describes symptoms of abdominal pain and vomiting, on a background of previous intermittent abdominal pain. The possibility of small bowel obstruction was suspected, and appropriate imaging was performed. This case illustrates the need for a high index of suspicion for small bowel obstruction, with appropriate investigations and review. It also highlights the limitations of imaging modalities in identifying complications of Meckel’s diverticulum. It is important to raise awareness of this fatal cause for small bowel obstruction and to help identify suggestive imaging features, which may point towards a possible complicated Meckel’s diverticulum. Earlier recognition and diagnosis could reduce morbidity and mortality.
