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Protein-losing enteropathy caused by a jejunal ulcer after an internal hernia in Petersen's space: A case report

World Journal of Clinical Cases 2022年第1期10卷 323-330页

作者： Tomohiko Yasuda Nobuyuki Sakurazawa Komei Kuge Jun Omori Hiroki Arai Daisuke Kakinuma Masanori Watanabe Hideyuki Suzuki Katsuhiko Iwakiri Hiroshi Yoshida Department of Gastrointestinal Surgery Nippon Medical School Chiba Hokusoh HospitalChiba 270-1694Japan Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Nippon Medical SchoolTokyo 113-8603Japan Department of Gastroenterology Nippon Medical SchoolTokyo 113-8603Japan

BACKGROUND The incidence of internal hernias has recently increased in concordance with the popularization of laparoscopic surgery.Of particular concern are internal hernias occurring in Petersen's space,a space that is surgically created after treatment for gastric cancer and obesity.These hernias cause devastating sequelae,such as massive intestinal necrosis,fatal Roux limb necrosis,and superior mesenteric vein thrombus.In addition,protein-losing enteropathy(PLE)is a rare syndrome involving gastrointestinal protein loss,although its relationship with internal Petersen’s hernias remains unknown.CASE SUMMARY A 75-year-old man with a history of laparotomy for early gastric cancer developed Petersen's hernia 1 year and 5 mo after surgery.He was successfully treated by reducing the incarcerated small intestine and closure of Petersen’s defect without resection of the small intestine.Approximately 3 mo after his surgery for Petersen’s hernia,he developed bilateral leg edema and hypoalbuminemia.He was diagnosed with PLE with an alpha-1 antitrypsin clearance of 733 mL/24 h.Double-balloon enteroscopy revealed extensive jejunal ulceration as the etiology,and it facilitated minimum bowel resection.Pathological analysis showed extensive jejunal ulceration and collagen hyperplasia with nonspecific inflammation of all layers without lymphangiectasia,lymphoma,or vascular abnormalities.His postoperative course was unremarkable,and his bilateral leg edema and hypoalbuminemia improved after 1 mo.There was no relapse over the 5-year follow-up period.CONCLUSION PLE and extensive jejunal ulceration may occur after Petersen's hernia.Doubleballoon enteroscopy helps identify and resect these lesions.

关键词： internal hernia Ulcer Protein-losing enteropathy Double-balloon enteroscopy Ischemia-reperfusion injury Case report

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Interest of Computed Tomography in the Diagnosis of Intestinal Obstruction Due to an internal hernia of Unusual Location: The Falciform Ligament

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Open Journal of Radiology 2023年第2期13卷 94-100页

作者： Diallo Moustapha Diack Aminata Ndaw Mame Diarra Bousso Amar Ndeye Isseu Diop Massamba Diouf Cheikh Tidiane Fall Amath Ndiaye Abdou Rahmane Soko Thierno Omar Mbengue Ababacar Department of Medical Imaging Dakar Principal Hospital Dakar Senegal

Pathological implications of the falciform ligament are rare and internal hernias are exceptional. The origin of the falciform ligament defect can be congenital or inflammatory (a satellite of acute cholecystitis) or even post-surgical. The internal hernias of the falciform ligament are most often revealed by an acute intestinal obstruction syndrome with an ischemic component. The scanner provides the benchmarking examination allowing us to conduct a positive diagnosis and see also the inherent complications, which drives us to take the appropriate and fast surgical procedures. It is an entity that must be known.

关键词： internal hernia Falciform Ligament Scanner

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internal hernia of Broad Ligament： ACT Scan Suspicion and Laparoscopic Treatment

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Journal of Pharmacy and Pharmacology 2018年第2期6卷 157-160页

作者： E. Dieme I. Sall A. R. Ndiaye M. Diouf S. M. Seek B. Ndiaye O. Fall A. Sow I-C. Diakhate M.Ogougbemy Department of Surgery Military Teaching Hospital Hospital Principal of Dakar Dakar BP3006 Senegal Medical lmaging Department Military Teaching Hospital Hospital Principal of Dakar Dakar BP3006 Senegal

internal hernia of the broad ligament is rare. Computerized tomography is the key tool of the diagnosis. The treatment is surgical and takes advantage of the use of laparoscopy. We report a case of internal hernia of ... 详细信息

关键词： internal hernia broad ligament computed tomography laparoscopy

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Transverse mesocolic hernia with intestinal obstruction as a rare cause of acute abdomen in adults:A case report

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世界临床病例杂志 2023年第27期11卷 6613-6617页

作者： Chun Zhang Deng-Fang Guo Feng Lin Wen-Feng Zhan Jian-Yuan Lin Gui-Fang Lv General Surgery Department Mindong Hospital Affiliated to Fujian Medical UniversityFu’an 355000Fujian ProvinceChina Medical Laboratory Mindong Hospital Affiliated to Fujian Medical UniversityFu’an 355000Fujian ProvinceChina

BACKGROUND internal hernia is a rare cause of acute abdomen and intestinal obstruction in adults.internal abdominal hernias include paraduodenal,perigastric,foramen of Winslow,intersigmoid,and post-anastomotic hernias and can be congenital or acquired.internal hernias occur in 1%-2%of patients,and transmesocolic hernias are extremely rare.This report presents a patient with a transverse mesocolic hernia with a preoperative diagnosis of small intestinal obstruction.CASE SUMMARY A 45-year-old Chinese woman was admitted to the hospital with middle and upper abdominal pain for 2 d,abdominal distension,and vomiting.After abdominal computed tomography,she was diagnosed with an internal abdominal hernia complicated by small intestinal obstruction and underwent emergency laparoscopic surgery.The patient recovered well and was discharged 6 d postoperatively.CONCLUSION Transmesocolic hernias must be considered in adult patients with signs and symptoms of intestinal obstruction,even without a history of abdominal trauma or surgery.

关键词： internal hernia Transmesocolic hernias Abdominal computed tomography Small bowel obstruction Laparoscopic surgery Case report

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Closed loop ileus caused by a defect in the broad ligament:A case report

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World Journal of Clinical Cases 2023年第5期11卷 1182-1187页

作者： Isabel Zucal Christian A Nebiker Department of General Surgery Cantonal Hospital of AarauAarau 5001Switzerland

BACKGROUND Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity.Only a few cases have been reported in the literature.CASE SUMMARY We present the case of a 44-year-old,healthy patient with no prior history of abdominal surgery who developed a closed loop ileus due to an internal hernia secondary to a defect in the right broad ligament.She first presented to the emergency department with diarrhea and vomiting.As she had had no previous abdominal surgery,she was diagnosed with probable gastroenteritis and discharged.The patient subsequently returned to the emergency department due to a lack of improvement in her symptoms.Blood tests showed an elevated white blood cell count and a closed loop ileus was diagnosed on an abdominal computer tomography scan.Diagnostic laparoscopy revealed an internal hernia entrapped in a 2 cm large defect in the right broad ligament.The hernia was reduced and the ligament defect was closed using a running,barbed suture.CONCLUSION Bowel incarceration through an internal hernia may present with misleading symptoms and laparoscopy may reveal unexpected findings.

关键词： Broad ligament Ileus internal hernia Laparoscopy Case report

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Easy fixation effects the prevention of Peterson’s hernia and Roux stasis syndrome

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World Journal of Gastrointestinal Surgery 2020年第8期12卷 346-354页

作者： Jian-Zhong Wu Hajime Orita Shun Zhang Hiroyuki Egawa Yukinori Yube Sanae Kaji Shinichi Oka Tetsu Fukunaga Department of Gastroenterology and Minimally Invasive Surgery Juntendo University School of MedicineJuntendo UniversityTokyo 1638001Japan Department of Gastroenterology Surgery Suzhou Ninth People’s HospitalNantong UniversitySuzhou 215000Jiangsu ProvinceChina Department of Surgery Tongji UniversityShanghai 200000China

BACKGROUND Laparoscopic distal gastrectomy(LDG)for gastric cancer has been progressed and popular in Japan,since it was first described in 1994.Several reconstruction methods can be adopted according to remnant stomach size,and balance of pros and cons.Roux-en-Y(R-Y)reconstruction is a one of standard options after LDG.Its complications include Petersen’s hernia and Roux stasis syndrome.Here we report our ingenious attempt,fixation of Roux limb and duodenal stump,for decreasing the development of Petersen’s hernia and Roux stasis syndrome.AIM To develop a method to decrease the development of Petersen’s hernia and Roux stasis syndrome.METHODS We performed ante-colic R-Y reconstruction after LDG.After R-Y reconstruction,we fixed Roux limb onto the duodenal stump in a smooth radian.Via this small improvement in Roux limb,Roux limb was placed to the right of the ligament of Treitz.This not only changed the anatomy of the Petersen’s defect,but it also kept a fluent direction of gastrointestinal anastomosis and avoided a cross-angle after jejunojejunostomy.31 patients with gastric cancer was performed this technique after R-Y reconstruction.Clinical parameters including clinicopathologic characteristics,perioperative outcomes,postoperative complication and follow-up data were evaluated.RESULTS The operative time was(308.0±84.6 min).This improvement method took about 10 min.Two(6.5%)patients experienced pneumonia and pancreatitis,respectively.No patient required reoperation or readmission.All patients were followed up for at least 3 year,and none of the patients developed postoperative complications related to internal hernia or Roux stasis syndrome.CONCLUSION This 10 min technique is a very effective method to decrease the development of Petersen’s hernia and Roux stasis syndrome in patients who undergo LDG.

关键词： Laparoscopy distal gastrectomy Roux-en-Y reconstruction internal hernia Roux limb syndrome Gastric cancer

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Abdominal separation in an adult male patient with acute abdominal pain

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World Journal of Gastroenterology 2010年第26期16卷 3343-3346页

作者： Liu, Bao-Lin Chen, Yang Liu, Shi-Qing Zhang, Xiao-Bo Cui, Dong-Xu Dai, Xian-Wei China Med Univ Shengjing Hosp Dept Surg Oncol & Organ Transplatat Div Shenyang 110004 Liaoning Prov Peoples R China

We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine. The membrane also formed an orifice in the ileal pars caeca, from which a 30 cm herniated ileum formed a "C"-shaped loop which was strangulated by the orifice. An abdominal separation was diagnosed after surgery. We liberated the membranous peritoneum which incarcerated the intestinal canal from the root ofileocecal junction to Treitz ligament, and reduced the small intestinal malrotation. The patient had an uneventful recovery after opera-tion with his abdominal distention disappeared during the follow-up. Abdominal separation is a rare situation, which may be related with embryo development. Surgery is a choice of treatment for it.

关键词： Abdominal separation Abdominal pain internal hernia Malrotation Acute abdomen

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右侧十二指肠旁疝:两例报告和文献复习

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Gastroenterology Report 2016年第2期4卷 168-171,I0003页

作者： Rohit Mehra Aswini Kumar Pujahari Department of Surgery Armed Forces Medical CollegePuneMaharashtraIndia

Paraduodenal hernia(PDH),a rare congenital anomaly,is a type of internal hernia which occurs due to a defect in the reduction and rotation of the midgut.On anatomical and embryological basis,PDH can be broadly divided into right-and Left PDH.Right PDH is rarer than its counterpart.We present two cases of Right PDH.The patientsy presented with a history of recurrent intestinal obstruction since childhood,which was managed conservatively,without a definitive diagnosis.Once they presented to us,a detailed clinical history and a barium meal follow-through clinched the diagnosis of PDH.Intra-operative findings correlated well with the clinical diagnosis.The jejunal loops had herniated through the fossa of Waldeyer.Reduction of hernia contents and excision of the hernia sac was carried out.Post-operatively,the patients are healthy and symptom-free at 4 and 3 years follow-up,respectively.The rarity of this condition and the need for early diagnosis,to prevent the high risk of bowel obstruction and strangulation,makes PDH one of the difficult challenges for the clinicians.

关键词： internal hernia paraduodenal hernia small bowel obstruction

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