Yasin Nor A, Ahmed Mohamed R, Mohammed Abdulkadir N, Ali Abdihamid M
Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia.
Ann Med Surg (Lond). 2024 Apr 3;86(10):6121-6124. doi: 10.1097/MS9.0000000000001931. eCollection 2024 Oct.
Internal hernia is responsible for 0.6-5.8% of all small intestinal obstructions. Only 8% of internal hernias are of the congenital trans mesenteric variant. Urgent surgical intervention should be considered in individuals who exhibit intestinal obstruction before the development of irreversible bowel ischemia and necrosis.
The authors report a 38-year-old male patient who presented to the emergency department with abdominal pain, distension, and vomiting for the last three days. After an explorative laparotomy, it was confirmed that there was a trans mesenteric hernia defect with strangulated distal ileal loops. End-to-end ileo-ileal anastomosis was done.
Early recognition and subsequent surgical treatment permit proper management and prevent complications. There should be a differential diagnosis. In this case, there is no prior history of abdominal surgery, and the patient presents with recurrent abdominal pain and intestinal obstruction.
Early diagnosis and emergency laparotomy can save the intestine before gangrene, lowering morbidity and mortality, correcting the mesenteric defect to prevent recurrences, and enhancing clinical outcomes because many studies have shown that some cases are missed before radiological investigation. Laparotomy is still the method of choice for acute cases of incarceration with bowel obstruction, strangulation, and ischemia. The entire mesentery needs to be evaluated, and all mesenteric defects need to be sutured to prevent recurrence.
内疝占所有小肠梗阻病例的0.6 - 5.8%。先天性经肠系膜型内疝仅占内疝的8%。对于出现肠梗阻且尚未发展为不可逆肠缺血坏死的患者，应考虑紧急手术干预。
作者报告了一名38岁男性患者，他因腹痛、腹胀和呕吐3天前来急诊科就诊。经剖腹探查，证实存在经肠系膜疝缺损，远端回肠袢绞窄。进行了端端回肠吻合术。
早期识别并随后进行手术治疗可实现妥善管理并预防并发症。应进行鉴别诊断。在此病例中，患者既往无腹部手术史，且出现反复腹痛和肠梗阻。
早期诊断和急诊剖腹手术可在肠坏疽前挽救肠管，降低发病率和死亡率，修复肠系膜缺损以防止复发，并改善临床结局，因为许多研究表明在进行影像学检查之前会漏诊一些病例。剖腹手术仍是急性肠梗阻、绞窄和缺血性嵌顿病例的首选方法。需要评估整个肠系膜，缝合所有肠系膜缺损以防止复发。
