A Case of Strangulated Ileus due to Epiploic Appendage of the Sigmoid Colon in an Incisional Hernia

Abstract

A 72-year-old woman visited our hospital because of epigastralgia and vomiting. She had had an incisional hernia about 25cm in diameter at the left lower quadrant of abdomen since around 40 years of age. Abdominal enhanced CT scan showed the sigmoid colon and the small intestine to have protruded into the incisional hernia, and enhancement efficacy of the small intestine was slightly reduced. However, there were no findings indicative of ileus, so we treated her conservatively after medical treatment. On the 3rd hospital day, no symptomatic remission was gained and abdominal enhanced CT scan showed disappearance of enhancement efficacy of the protruded small intestine into the incisional hernia and appearance of findings of ileus. We performed emergency operation. During the operation, the descending colon and the sigmoid colon protruded into the incisional hernia, and epiploic appendage of the sigmoid colon adhering to the sac caused strangulation of the small intestine. We performed dissection of the adhering epiploic appendage, small bowel resection, and repair of the incisional hernia.
There have been few reports of ileus in an incisional hernia or strangulated ileus caused by epiploic appendage. We report our case, along with review of the relevant literature.