A case report of an incarcerated internal hernia with a rare hernia opening

Abstract

An 82-year-old man was seen at the department of internal medicine in our hospital because of abdominal pain and vomiting. There was no history of laparotomy. Thereafter he developed anal bleeding and emergency upper and lower gastrointestinal endoscopies disclosed bleeding from the small intestine. Following various examinations, strangulated ileus was suspected and emergency laparotomy was performed at our surgical department. Upon laparotomy, and about 76-cm portion of the jejunum 40cm apart from the Treitz ligament had been impacted and strangulated as it was sandwiched between the greater omentum and descending colon, where had become necrotic. The hernia opening was released and the necrotic intestine was removed. The postoperative course was uneventful, however, the patient died of aspiration pneumonia at a day when his discharge day became close.
Internal hernias are comparatively rare and lack characteristic clinical findings, leading to difficulties in making the preoperative diagnosis. This case of internal hernia which was caused by the jejunal incarceration into the normal anatomical structures is considered rare, so that this case is reported here together with a review of the literature.