Lisa Zhang, MD, Boris Zevin, MD, PhD. Queen’s University
Intersigmoid hernia is a rare type of congenital internal hernia and one of three subtypes of sigmoid mesocolon hernia. In this video, we describe the case of a 54 year old male with no prior abdominal surgeries who presented to our hospital with 24 hour history of nausea, emesis, and lower abdominal pain. CT scan demonstrated a small bowel obstruction with the transition point at the proximal ileum, which appears as an internal hernia through the sigmoid mesocolon. After appropriate resuscitation measures and nasogastric tube insertion, the patient was taken urgently to the operating room for an exploratory laparoscopy. Intraoperative examination revealed an incarcerated loop of ileum in the intersigmoid fossa. The hernia was successfully reduced and the hernia defect was closed; the small bowel was not necrotic and resection was not necessary. The patient had an uncomplicated postoperative course and was discharged home on postoperative day 2. Sigmoid mesocolon hernias were historically difficult to diagnose; mortality rates exceeded 50% in the presence of strangulation. Congenital internal hernias should be suspected in patients presenting with obstructive symptoms, no prior abdominal surgeries, and no evidence of abdominal wall hernias. Early operative intervention is recommended to minimize strangulation, conserve bowel, and reduce patient morbidity and mortality.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93235
Program Number: V101
Presentation Session: Exhibit Hall Theater Video Session IV
Presentation Type: EHVideo