Two Pediatric Cases of Internal Hernia Associated With the Appendix

Abstract

Case 1: A 7-year-old boy who had been receiving conservative therapy for acute appendicitis underwent Computed Tomography (hereinafter referred to as CT) owing to chronic abdominal pain and fever. Since a closed loop with a twisted bowel was observed at the navel level on CT, the patient underwent emergency surgery. We identified a band formed at the tip of the appendix and greater omentum at the place where we had earlier observed a closed loop on his CT images. We surmised that ileal invagination led to the development of strangulation ileus in the crevice. Case 2: A 5-year-old boy presented with intermittent abdominal pain and vomiting. Although the symptoms had improved once, they recurred thereafter and worsened. Therefore, he was diagnosed as having paralytic ileus on the basis of abdominal X-rays and was thus immediately hospitalized. Since the patient did not show any improvement in his symptoms, he thus underwent CT. A closed loop with two twisted bowels was observed on his CT images, and he was therefore transferred to our hospital to undergo emergency surgery. We found that the tip of the appendix adhered to the small intestine at a point some 70 cm from Bauhin’s valve. The small intestine was invaginated and slightly twisted in the crevice. In addition, we also observed a small tumor at a point where the appendix adhered to the small intestine, and the tumor was diagnosed as Meckel’s diverticulum on the basis of histopathological findings. The occurrence of strangulation ileus associated with the appendix is a relatively rare phenomenon. We herein describe our two experiences and with pertinent bibliographical considerations.