Demin Aleksandr, DO, Ajit Singh, DO, Noman Khan, DO. Flushing Hospital
Introduction: Internal hernias are known complications that are well documented to involve Peterson’s defect. In bariatric patient’s post gastric bypass there is a high index of suspicion for internal hernias as well as a low threshold to operate. There have been some debates around the closure of the potential Peterson’s space with several studies advocating closure versus some which show that there is no difference in the rate of symptomatic internal hernias. We present a case of an unusual cause of small bowel obstruction due to internal hernia caused by a cecal volvulus. It is an atypical presentation however the patient was triaged and brought to the OR within 5 hours of admission. Although it is rare there have been reports of internal hernias caused by other structures like congenital bands or natural potential spaces. There have been reports of unusual presentations of the cecum herniating through the foramen of Winslow. The anatomical rearrangements after bypass create potential areas where an internal hernia can occur. In this case a bowel resection was undertaken due to the anatomical variation of the cecal bascule and cecal volvulus due to high rate of recurrence of this cecal pathology. Majority of internal hernias do not require bowel resection especially when detected earlier and prompt surgical exploration is undertaken. Mortality as direct consequence internal hernia is extremely rare. However late diagnosis of internal hernias can lead to catastrophic gut loss and may require lifelong TPN and/or visceral transplantation or autologous reconstruction.
Conclusion: Careful history and physical of our bariatric patient can elicit the signs and symptoms of internal hernias and prevent the morbidity and mortality that can come with the complications of this condition. Unusual presentations and causes are reason for prompt diagnosis and complete exploration
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86308
Program Number: P069
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster