Three cases of internal hernia prsenting as strangulated ileus

Abstract

Strangulated ileus is a serious disease which can progress to intestinal necrosis if the diagnosis is delayed and the chance for surgery lost. We report three cases of strangulated ileus caused by internal herniation into an abnormal hiatus of the greater omentum and transverse mesocolon. The courses differed but went well after surgery. Case 1 : A 67-year-old man. He had sudden abdominal pain, and was diagnosed with strangulated ileus by computed tomography. Jejunectomy was performed as the jejunum incarcerating through the hiatus of greater omentum showed ischemic change. Case 2 : A 55-year-old woman. Intestinal obstruction was sustained after insertion of a long nasointestinal tube. Intra operatively, some of the ileum showed ischemic change and the omentum had an organized hiatus. Omentectomy was performed. Case 3 : A 73-year-old woman. Upper gastrointestinal series performed for evaluation of bile vomitus revealed a constriction of the jejunum. Laparotomy revealed some of the small intestine incarcerating through the hiatus of transverse mesocolon into the omental bursa and it was strangulated. Internal hernia is difficult to diagnose especially in the absence of symptoms. It is very important to make full use of diagnostic images such as enhanced computed tomography or upper gastrointestinal series at the time of symptom manifestation.