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Objective: The aim of this study was to evaluate the risk of bowel obstruction, incisional, and parastomal hernia following laparoscopic versus open surgery for rectal cancer., Summary Background Data: Laparoscopic surgery for rectal cancer has been adopted worldwide, after trials reported similar oncological outcomes compared with open surgery. Little is known about long-term morbidity, including bowel obstruction, incisional, and parastomal hernia following surgery., Methods: Patients included in the international, multicenter, noninferior, open-label, randomized COLOR II trial were followed for five years. Primary endpoint was local recurrence at 3-year follow-up. Secondary endpoints included bowel obstruction, incisional and parastomal hernia within 5 years, and the current article reports on these secondary endpoints., Results: All 1044 patients included in the COLOR II trial were analyzed. There was no difference in risk of bowel obstruction, incisional, or parastomal hernia following laparoscopic or open surgery for rectal cancer., Conclusion: Based on long-term morbidity outcomes, laparoscopic surgery for rectal cancer could be considered a routine technique as there are no differences with open surgery.

BACKGROUND While it is well known that abdominal wall hernias can pose obstacles for colonoscopy, these may not be obvious in obese patients, particularly when the hernia is in an unusual place. CASE REPORT A 62-year-old man presented with inability to complete colon cancer screening by means of colonoscopy or barium enema. On exam, he was noted to have a Spigelian hernia present in his left lower quadrant abdominal wall. CT colonography identified incarcerated sigmoid colon within the hernia accounting for his inability to complete colonoscopy or barium enema. Repair of his Spigelian hernia was thus performed, allowing for ease of future colorectal cancer screening. CONCLUSIONS Colorectal cancer screening is an evidence-based benchmark for effective primary care, but is often ordered and interpreted like a blood test, without reference to the technical aspects of the procedure. Failure of colonoscopy requires examination of the patient and consideration of why the procedure failed. In particular, patients in whom colonoscopy fails must be carefully evaluated for occult partially obstructing hernias.

The aim of work was to improve the results of treatment of patients with strangulated ventral hernias by prostheses of the abdominal wall using mesh implants and laser therapy. A detailed analysis and evaluation of the comparative of traditional methods and prosthetic plastics with infringement inguinal, umbilical, femoral and postoperative ventral hernias was performed on huge clinical material. The studies confirm that the integrated approach in treating patients with this pathology helps to improve the results of surgical treatment, reduction of postoperative complications, time of rehabilitation of patients and recurrence of herniation in comparison with traditional ways of hernioplasty.

Spigelian hernia is a rare abdominal wall defect usually appearing between the abdominal muscle lateral to the rectus abdominis and through a debilitated spigelian aponeurosis. Spigelian hernias account for 0.12% to 2.4% of all abdominal wall hernias with a 17-24% risk of strangulation. We report the case of a 77-year-old male that presented with small bowel obstruction with incarcerated spigelian hernia which was successfully treated with a Ventralex hernia patch (Bard Access Systems, Inc., Murray Hill, NJ). A small open incision over the incarcerated hernia was a safe and effective method of repairing an incarcerated spigelian hernia in an urgent fashion.

Paraduodenal hernia is a rare situation, less than 400 cases being published in literature. This condition is difficult to explore, diagnose appear within an occlusive syndrome. The etiopathology involves perturbation of intestinal rotation during the intrauterine life, producing paraduodenal fossa, which generates conditions for internal hernias and occlusive situations. We present the case of a 36 years old woman with chronic epigastric pain, diagnosed as duodenal ulcer, later as acute pancreatitis and in the end as high occlusion syndrome. Open laparotomy was performed, uncovering a strangulated left paraduodenal hernia, with severe pathologic lesions of the intestinal loops. Kelotomy and pure-string suture of parietal defect was performed. Post-operative evolution has been difficult with hepatic failure with coagulopathy and diffuse intestinal hemorrhage, threatening the patient's life. Intensive care lead eventually to a favorable condition. The rarity of this disease, difficulty of diagnosis and the particular evolution were the reasons to present this rare case.

Spigelian hernia is a ventral abdominal hernia that only rarely causes incarceration or strangulation of the bowel. There are few reports in the surgical literature of colonic obstruction secondary to incarcerated Spigelian hernia. In this paper, we present a patient with an incarcerated sigmoid colon in a Spigelian hernia sac, mimicking on contrast enema an obstructing carcinoma. Accurate diagnosis was made pre-operatively by computed tomography (CT), and the hernia was repaired by polypropylene mesh in a tension-free manner.

Internal hernia is rare its frequency ranging between 0.6 and 5.8%. It results from the protrusion of one or more abdominal viscera (usually small bowel) through an intraperitoneal opening. The opening can be normal (e.g. Winslow foramen), congenital (paraduodenal fossa, ileocecal fossa), or abnormal anatomical entities (after trauma or surgery). The clinical diagnosis of internal hernia is difficult because of the lack of specific signs and symptoms. There is a 63.6% lifetime risk of strangulation and bowel ischemia. In such cases, computed tomography is essential in the preoperative diagnosis because of the high mortality rate (20%) (which justifies its costs).

Hernias can lead to significant morbidity in patients on peritoneal dialysis (PD). We studied the natural history and outcome of incarcerated hernia (IH), with or without bowel strangulation (IHS), in PD patients. We performed a retrospective chart review on all PD patients who developed an IH (n = 11) or an IHS (7/11) in the last 12 years. Of the 11 patients, 54% were female. The age range was 36 - 86 years (median: 61 years). Seven patients had a known history of a hernia that went on to become the index hernia that incarcerated with or without strangulation. The hernia types were umbilical (n = 8), inguinal (n = 2), and incisional in the area of the PD catheter (n = 1). Clinical presentations included painless abdominal mass (2 patients); tender and painful abdominal mass (4 patients); and abdominal pain, tenderness, and bowel obstruction (5 patients). Nine hernias were treated surgically--5 of them emergently for bowel ischemia. The other 4 patients who had incarcerated, non strangulated hernias were operated electively. One patient with IHS had the hernia manually reduced, and 1 patient with IHS had the hernia manually reduced and subsequently operated electively. Three patients with IHS and 2 with IH required temporary hemodialysis for between 4 days and 21 days. In PD patients, IHs are most commonly umbilical and have a propensity to strangulate. Patients treated operatively have an excellent prognosis and are usually able to continue PD. Abdominal wall hernias should be referred early to minimize mechanical complications.

The Authors report a rare case of Meckel's diverticulum complicated by diverticulitis and a small bowel obstruction due to enteroliths, associated to a paracecal internal hernia. Computed tomography was useful for surgical planning.

The application of diagnostic laparoscopy in emergency surgery has facilitated a wide range of endoscopic operative procedures. We report an extremely rare case of a patient who had a bowel obstruction caused by an internal supravesical hernia that was repaired via a minimally invasive technique. Abdominal computed tomography (CT) showed signs of small bowel obstruction: the cause was thought to be an invagination due to a small bowel tumor. Laparoscopic exploration of the dilated small bowel segments allowed the diagnosis of supravesical hernia. Reduction was performed with slight traction, and the hernial orifice was closed with intracorporeal sutures. To our knowledge, this is the first repair of an internal supravesical hernia ever to receive herniorraphy based on laparoscopic techniques. The mean starting time for bowel-function and mean hospital stay following the laparoscopic release of the intestinal obstruction were significantly shorter than is typically seen with standard techniques.

Introduction: We report a case of transomental herniation of the ileum through a defect in the gastrocolic ligament with re-emergence through a defect in the gastrohepatic ligament. This type of herniation is extremely rare and a review of the literature is presented., Clinical Presentation: A 41-year-old Chinese male presented with signs and symptoms of intestinal obstruction., Treatment: An urgent laparotomy was undertaken and he was found to have a rare form of intra-abdominal hernia. The hernia was reduced and the defects were closed., Outcome: Postoperative recovery was unremarkable., Conclusion: Urgent operation should not be delayed because of the high mortality associated with strangulation.

A 3-year-old boy presented with small bowel obstruction resulting from incarceration of the distal ileum in a mesentric defect. Attempted laparoscopy was unsuccessful. The hernia was reduced successfully at laparotomy., (Copyright 2002, Elsevier Science (USA). All rights reserved.)

A 71-year-old woman presented with vomiting, abdominal pain and vague right gluteal discomfort. Abdominal ultrasound showed ascites and dilated small bowel loops with peristaltic movement, while transgluteal ultrasound revealed entrapped ascites beneath gluteal muscles and an oedematous, immobile bowel loop trapped between the sacrum and iliac bone with barely visible colour Doppler flow suggestive of an incarcerated sciatic hernia. CT demonstrated similar findings and subsequent surgery confirmed the diagnosis. To our knowledge, this is the first report of a pre-operative diagnosis of incarcerated sciatic hernia on ultrasound.

We report a case of internal hernia of the small intestine in a 13-year-old boy with presentation of partial intestinal obstruction. The patient suffered from recurrent abdominal pain and chronic constipation over the past few years. An abdominal mass was suspected from clinical manifestations and images derived from abdominal echography. Upper gastrointestinal contrast study revealed poor motility at the distal jejunum with barium stasis. Follow-up film on the next day delineated medially and downwardly displaced splenic flexure and proximal descending colon. At operation, total herniation of small intestine into a retroperitoneal space through a defect on left mesocolon was noted. A left paraduodenal (mesocolic) hernia was diagnosed. The patient made an uneventful recovery after the hernia was repaired. This report provides unusual image clues of internal hernias of the small intestine presenting as ileus. Though rare, paraduodenal hernia should be taken into account in a differential diagnosis of intestinal obstruction. Early surgical intervention allows uneventful recovery to occur and also prevents the possible complication of gangrenous bowels.

Purpose: To review the incidence, cause, and radiologic findings of bowel obstruction in patients who have undergone orthotopic liver transplantation (OLT)., Materials and Methods: Retrospective review of 4,001 cases of OLT revealed 48 cases of bowel obstruction in 44 patients. Seventeen computed tomographic (CT) scans and seven barium-enhanced radiographs were reviewed to determine level and cause. Surgical proof was available in 45 cases, while three had characteristic clinical and radiographic features., Results: Adhesions caused the obstruction in 19 cases in 16 patients; three had bowel ischemia. Internal hernias caused obstruction in 18 patients; all obstructions were transmesenteric or retroanastomotic and occurred with choledochoenteric anastomosis. Seven patients had volvulus; four had bowel ischemia. CT signs of internal hernia included mesenteric vascular abnormalities and clusters of dilated small-bowel segments that displaced the colon away from the abdominal wall. Prospective diagnosis of internal hernia was made in only one case. Incisional or inguinal hernia caused obstruction in seven patients; CT was used just once. Four patients had neoplastic bowel obstruction, three due to posttransplantation lymphoproliferative disorder and one due to colon carcinoma., Conclusion: Liver transplantation was complicated by bowel obstruction in 48 (1.2%) of 4,001 cases. While adhesions and incisional hernias are common and well recognized, other causes are more challenging to diagnose. The CT findings reported here may allow more accurate diagnosis of internal hernia.

The most common causes for small-bowel obstructions with subsequent strangulation are intra-abdominal adhesions and external hernias. We report an unusual case of strangulated small-bowel hernia through a congenital window in the falciform ligament. The diagnosis and surgical treatment are discussed.

We report herein the case of a 65-year-old woman who was referred to our department with prolonged ileus symptoms despite conservative therapy. A plain abdominal radiograph showed intestinal gas shadows with an air-fluid level in the lesser curvature of the stomach. As no improvement was achieved by the insertion of a short tube, a long tube was inserted. A loop formation of the long tube in the subphrenic region was detected on an abdominal radiograph, and an enterogram showed an interruption in the ileum in the lower abdomen. The patient was diagnosed as having an adhesional ileus and a strangulated ileus due to a lesser sac hernia. A laparotomy was performed which revealed that the small intestine had herniated into the lesser sac space through a hiatus of Treitz' fossa and a hiatus in the transverse mesocolon. Furthermore, part of the small intestine had herniated through an omental hiatus. The herniated intestine was manually reduced and the hiatus was closed. However, as the right ovary was found to have adhered to the ileum and stenosis was seen, we were forced to perform partial resection of the ileum. Considering that this patient had no history of laparotomy in the upper abdomen, abdominal injury, or acute abdomen, it was surmised that the three abnormal hiatuses were congenital.

Three-hundred-thirteen cases of small and large bowel obstructions surgically managed, from May 1974 to September 1995, are reviewed. Particularly, 10 uncommon cases are described: 3 hernias in anomalous recesses, 1 small bowel spontaneous hematoma, 2 Ogilvie syndromes, 1 obstruction due to cholecystitis, 1 left diaphragmatic hernia, 1 encapsulating peritonitis, 1 incarcerated Spigelian hernia. Their aetiopathogenetic and clinical patterns are examined. The Authors conclude, in agreement with Literature, that small bowel obstructions need urgent operation because of high risk of ischemic lesions. In large bowel obstructions operation is suggested after more careful diagnostic researches and adequate patient preparation. In some uncommon obstructions the purpose is to restore normal anatomical conditions.

Hernias through Winslow's hiatus are rare and give rise to serious diagnostic difficulties, hence the rarity of preoperative diagnoses. On the basis of one new exceptional case of hernia of the right colon, and in the light of the worldwide literature, we have summed up the main clinical and radiological signs of the condition, as well as the therapeutic strategy.

A previously unreported case of colonic obstruction secondary to incarcerated spigelian hernia is presented. The diagnosis was suspected preoperatively, based on the results of a barium-enema examination. Available diagnostic techniques are reviewed.