An Unusual Case of Internal Hernia Caused by Adhesion between the Sigmoid Colon and Salpingectomy Site

Pyong Wha Choi^1,

¹Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Korea

Cite this paper

Pyong Wha Choi. An Unusual Case of Internal Hernia Caused by Adhesion between the Sigmoid Colon and Salpingectomy Site. American Journal of Medical Case Reports. 2017; 5(4):83-85. doi: 10.12691/AJMCR-5-4-2

Abstract

Internal hernia, in which the bowel herniates through a congenital or acquired aperture in the peritoneal cavity, is one of the rarest causes of ileus. Postoperative adhesion is a common pathological phenomenon that may cause bowel obstruction by angulation or twisting. However, internal herniation through a colonic adhesion formed after gynecologic surgery is extremely rare. Here, we present a case of strangulated small bowel obstruction in a 51-year-old woman, due to internal hernia through the aperture created by adhesion of the sigmoid colon and a right salpingectomy site. The patient presented with abdominal pain and distension; she had a history of right salpingectomy for ectopic pregnancy 20 years earlier. While attempting conservative management, peritoneal irritation signs developed and emergency surgery was performed. During the operation, it was found that approximately 30 cm of the ileum had herniated through the aperture created by the adhesion. After reduction of the incarcerated small bowel, bowel resection with primary anastomosis and adhesiolysis was performed. Although preoperative diagnosis is difficult in unusual types of internal hernias, due to their rarity, a high degree of suspicion and prompt management is crucial for the prevention of morbidity and mortality.

Keywords

hernia, colon, adhesion, salpingectomy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Blachar A., Federle M.P., Dodson S.F., “Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria,” Radiology, 218(1). 68-74. January 2001.
[2]	Salar O., El-Sharkawy A.M., Singh R., Speake W., “Internal hernias: a brief review,” Hernia, 17(3). 373-377. June 2013.
[3]	Choi P.W., “Strangulated Small Bowel Obstruction Caused by Broad Ligament Hernia: Report of a Case and Review of Literature,” American Journal of Medical Case Report, 5(2). 38-40. 2017.
[4]	Liakakos T., Thomakos N., Fine P.M., Dervenis C., Young R.L., “Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management,” Dig Surg, 18(4). 260-273. 2001.
[5]	Ghahremani G.G., “Internal abdominal hernias,” Surg Clin North Am, 64(2). 393-406. April 1984.
[6]	Garza Jr. E., Kuhn J., Arnold D., Nicholson W., Reddy S., McCarty T., “Internal hernias after laparoscopic Roux-en-Y gastric bypass,” Am J Surg, 188(6). 796–800. December 2004.
[7]	Ellis H., Moran B.J., Thompson J.N., Parker M.C., Wilson M.S., Menzies D., McGuire A., Lower A.M., Hawthorn R.J., O'Brien F., Buchan S., Crowe A.M., “Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study,” Lancet, 353(9163). 1476-1480. May 1999.
[8]	Rana P., Kazmi I., Singh R., Afzal M., Al-Abbasi F.A., Aseeri A., Singh R., Khan R., Anwar F., “Ectopic pregnancy: a review,” Arch Gynecol Obstet, 288(4). 747-757. October 2013.
[9]	Johns A., “Evidence-based prevention of post-operative adhesions,” Hum Reprod Update, 7(6). 577-579. December 2001.
[10]	Ward B.C., Panitch A., “Abdominal adhesions: current and novel therapies,” J Surg Res, 165(1). 91-111. January 2011.
[11]	Park J.H., Jeong S.H., Lee Y..J, Choi S.K., Hong S.C., Jung E.J., Jeong C.Y., Ju Y.T., Ha W.S., “Current status of the use of antiadhesive agents for gastric cancer surgery: a questionnaire survey in South Korea,” J Korean Surg Soc, 84(3). 160-167. March 2013.