Internal Hernia through a Congenital Peritoneal Defect in the Pouch of Douglas causing Small Bowel Obstruction
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Hellenic Journal of Surgery (2020) 92:3-4, 138-140
Internal Hernia through a Congenital Peritoneal Defect in the Pouch of Douglas causing Small Bowel Obstruction Kounoudes C1, Veloudis G2, Katopodis P3, Malamas M4, Gourgiotis S5
Abstract An internal hernia is defined as the protrusion of visceral content, most commonly the small bowel, through a normal or abnormal peritoneal or mesenteric aperture within the abdominal cavity and the pelvis. An internal hernia may either be congenital or acquired in aetiology. These hernias can trap and/or twist small bowel, resulting in bowel obstruction. We herein describe an extremely rare case of a young female who presented with small bowel obstruction secondary to an incarcerated internal hernia caused by a peritoneal defect in the pouch of Douglas. Key words: Internal hernia; laparotomy; small bowel; obstruction; surgery
Introduction Internal hernias involve protrusion of the viscera through normal or abnormal apertures into the peritoneal cavity. The extension of the viscus could be found through the peritoneum, the mesentery and into a compartment in the abdominal cavity [1]. Internal hernias can be divided into congenital or acquired hernias [2]. Congenital hernial orifices include normal foramina or recesses and unusual apertures resulting from anomalies of peritoneal attachment and internal rotation, while the acquired hernias are mostly iatrogenic secondary to surgically created defects in the mesentery and adhesions from prior surgery; inflammation and trauma as additional mechanisms of herniation have also been observed [3,4]. Although internal hernias represent an incidence ranging from 0.2-0.9%, these hernias are responsible for up to 5.8% of all small bowel obstructions with a high overall mortality rate that can exceed 50% [5-7]. They remain a potentially life-threatening condition and a surgical emergency since the bowel entrapment in the defects can lead to
1
MD, Surgical Department MD PhD FACS, Surgical Department 3 MD, Medical Department 4 MD, Radiology Department Athens Medical Center - Peristeri Clinic, Athens, Greece 2
5
MD PhD FACS FEBS FRCS, Department of Surgery, Addenbrooke’s Cambridge University Hospitals, Cambridge, UK Corresponding author: Stavros Gourgiotis MD PhD FACS FEBS FRCS Department of Surgery, Addenbrooke’s Cambridge University Hospitals, UK Tel.: +44 1223 250783, Fax: +44 1223 217473 e-mail: [email protected] Received May 25, 2020; Accepted Jun 28, 2020
Hellenic Journal of Surgery 92
intestinal obstruction with rapid evolution into strangulation and bowel ischaemia. The clinical presentation is not always clear because the symptoms may be intermittent or permanent, which leads to difficulty in diagnosis. Thus, otherwise healthy patients with virgin abdomens can present with persistent obstructive symptoms with an unrevealing physical exam. The purpose of this article is to present an extremely rare case of 16-year-old female with no previous abdominal surgery who presented with small bowel obstruction (SBO) of the distal
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