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Although rare, internal hernias have an increased incidence of development in patients who have undergone Roux-en-Y gastric bypass. They are difficult to diagnose given their non-specific presentation and lack of externally visible findings, and most cases develop within a few months of the original procedure. In this case report, we present a patient with recent weight loss who developed an internal hernia decades post-bariatric surgery with computed tomography findings showing the classic "mesenteric swirl" sign.

Introduction: The remnant of the omphalomesenteric duct is one of the rarest congenital malformation associated with a defect in the closure of the yolk sac. Its clinical manifestation in adulthood is uncommon and is related to multiple abdominal complications. The objective of this article was to present the case of a patient with intestinal obstruction secondary to the persistence of the omphalomesenteric duct. Clinical case. The case of a 19-year-old male patient with symptoms of intestinal obstruction and tomographic findings that suggested a transition zone in thin intestinal loops, for which he was taken to surgery. Results: In the exploratory laparoscopy, a fibrotic band was found firmly adhered to the small intestine, configuring an internal hernia, which caused intestinal obstruction and great dilation of the loops, so it was decided to convert to laparotomy. The structure described was resected without complications and the patient progressed satisfactorily. The pathology reported a remnant of the omphalomesenteric duct. Conclusions: The persistence of the omphalomesenteric duct is an uncommon cause of intestinal obstruction in adult patients; however, it is important to keep it in mind within the differential diagnoses of intestinal obstruction and perform confirmatory histopathological studies. [ABSTRACT FROM AUTHOR]

Bariatric surgery complications carry a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of bariatric surgery complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Bariatric surgeries include restrictive procedures (e.g., adjustable gastric banding, endoscopic gastric balloon insertion, and sleeve gastrectomy) and mixed restrictive and malabsorptive procedures (e.g., roux-en-y gastric bypass and duodenal switch-biliopancreatic diversion). Several complications may occur, which may be associated with severe morbidity and mortality. These complications include anastomotic/staple line leaks, small bowel obstruction and internal hernia, marginal ulceration, biliary disease, and device-specific issues. History concerning the type of surgery, when and where it was performed, prior complications, changes in weight, and systemic symptoms is essential. Many signs and symptoms are subtle, but fever, tachycardia, and persistent vomiting are concerning for a severe complication. If there is concern for a complication, emergent consultation with the bariatric surgeon is recommended (preferably the patient's surgeon). Imaging studies can assist in the evaluation, including computed tomography with oral and intravenous contrast. Resuscitation in the ED and early intervention by a bariatric surgeon provide the best opportunity to reduce morbidity and mortality for patients with intra-abdominal pathology. Understanding bariatric surgery complications can assist emergency clinicians in diagnosing and managing this potentially deadly disease. [ABSTRACT FROM AUTHOR]

Summary Biliopancreatic diversion with duodenal switch (BPD‐DS) and single anastomosis duodeno‐ileostomy with sleeve (SADI‐S) are associated with superior and sustained weight loss outcomes. Despite their growing popularity, long‐term safety profiles, particularly the risk of internal hernia (IH), remain underexplored. This study aimed to evaluate the incidence and characteristics of IH following BPD‐DS and SADI‐S procedures, comparing their clinical presentation, diagnostic methods, and outcomes. A retrospective chart review was performed for patients who underwent BPD‐DS or SADI‐S between 2008 and 2023 in two high‐volume tertiary referral centres for bariatric surgery in the United States. Demographic data, comorbidities, operative details, and follow‐up outcomes were collected. A subgroup analysis of IH cases was conducted to compare the incidence, location of hernias, and diagnostic modalities between procedures. Out of 1160 patients (85.1% BPD‐DS; 14.9% SADI‐S), the overall incidence of IH was 1.12%, with a higher rate in BPD‐DS (0.8%) than in SADI‐S (0.57%). Most IHs occurred within the first 24 months postoperatively. The majority of IHs in BPD‐DS patients were in the pseudo‐Petersen's space. The single IH case in the SADI‐S group occurred in the same space. Most patients presented with abdominal pain and were diagnosed by CT imaging. SADI‐S showed a lower IH rate compared to BPD‐DS, but further studies are needed to confirm these findings. The variability in clinical presentation complicates the diagnosis of IH, emphasizing the need for increased clinical vigilance. [ABSTRACT FROM AUTHOR]

Internal hernias after Roux-en-Y gastric bypass are one of the most common complications in bariatric surgery leading to hospital readmissions with or without surgery. Due to the insidious and non-specific clinical presentation combined with difficult radiological identification, internal hernias remain a diagnostic and therapeutic challenge. Delay in diagnosis and treatment can lead to severe morbidity and mortality. We report the case of a patient presenting an unusual intestinal obstruction due to two simultaneous and distinct internals hernias affecting the Petersen's defect and the foramen of Winslow 4 years after a laparoscopic gastric bypass. A 41-year-old female patient with a history of robotic laparoscopic Roux-en-Y gastric bypass presented with proximal small bowel obstruction symptoms and epigastric pain. Computed tomography showed two simultaneous internal hernias, one affecting the Petersen's defect and the other affecting the foramen of Winslow with an incarcerated transverse colon. We performed an explorative laparoscopy to reduce both hernias and, after an assessment of bowel viability by indocyanine green angiography, we closed both defects with interrupted non-absorbable sutures to prevent recurrence. The follow-up of more than 1 year has been uneventful. In the cases of obstruction and hospital admission after gastric bypass, we suggest that patients undergo a computed tomography directly after the initial examination. Internal hernia diagnosis is often delicate and requires surgical exploration since bowel strangulation can lead to dramatic outcomes. The operation can be safely done laparoscopically, and all internal hernia defects should be repaired with non-absorbable sutures. [ABSTRACT FROM AUTHOR]

Internal hernias, including Left para duodenal Hernias (LPDH), are rare and challenging to diagnose due to their nonspecific symptoms and complex anatomical presentation. This report presents a unique case of a 29-year-old female with preoperatively diagnosed uncomplicated LPDH, complicated by distal bowel ischemia—a manifestation not extensively documented in existing literature. Initial imaging revealed dilated jejunal loops indicative of LPDH, with subsequent contrast-enhanced computed tomography (CECT) showing ischemic changes in bowel segments distal to the hernia. Surgical exploration confirmed 120 cm of gangrenous bowel, necessitating resection and jejunostomy. This case highlights the diagnostic and therapeutic challenges of LPDH and highlights the crucial role of advanced imaging in identifying associated complications.

Internal hernia is the protrusion of a viscus through a normal or abnormal peritoneal or mesenteric aperture within the confines of the peritoneal cavity. They can be congenital or acquired after abdominal surgery. We report a case of a 58-year-old woman who presented with complaints of abdominal pain and nonbilious vomiting for 2 days. She underwent an abdominal hysterectomy 15 years ago. After baseline blood investigations and imaging, a diagnosis of subacute intestinal obstruction was made. As she clinically worsened over 24 h, CT imaging was done, which suggested acute small bowel obstruction secondary to adhesions. Surgery revealed herniation with incarceration of distal ileal loops through a defect in the sigmoid mesocolon. Bowel resection was done, and the defect was closed. The clinical presentation of internal hernias, especially transmesosigmoid hernia, is nonspecific, and they rapidly progress to bowel ischemia. Early intervention and surgical correction are prudent for good clinical outcomes.

Congenital diaphragmatic hernia (CDH) and acquired diaphragmatic hernia (ADH) are secondary to a weakness or opening in the diaphragm. Both are types of internal hernia. The abnormality can range from a minor defect in the posterior edge of the diaphragm to the entire loss of it. CDH usually leads to lung hypoplasia associated with pulmonary hypertension and immaturity, as well as cardiac dysfunction. In ADH, pathophysiology is secondary to herniation and its pressure effects. We report a series of two cases of spontaneous ADH (SADH). Spontaneous acquired rupture of the diaphragm can occur after exercise, coughing, labor (delivery), or even without any significant preceding event. It is uncertain if SADH is caused by a preexisting weak region in the diaphragm, a loss of muscle coordination during vigorous exertion, or both. It is a potentially fatal surgical emergency requiring a high index of clinical judgment in the appropriate clinical setting. SADH acts mechanically by compressing the lung. It is an infrequent entity. This case series and review concisely illustrate the genesis, diagnosis, and treatment of spontaneous diaphragmatic hernia.

Following gastrojejunostomy in Roux-en-Y gastric bypass (RYGB), the mesentery is susceptible to Petersen's hernia due to a mesenteric gap created between the alimentary limb, transverse mesocolon, and retroperitoneum. Although the Petersen's hernia is a rare complication, it has increased due to the widespread adoption of gastric bypass surgeries for weight management and gastric cancer resections. Computed tomography (CT) is commonly used to evaluate suspected cases.We present a case of a 36-year-old female who developed Petersen's hernia 3 weeks post RYGB. This report highlights key radiologic features, such as the whirl sign and mushroom-shaped mesentery in recognizing Petersen's hernia. Given the small sample sizes in current literature, this case contributes valuable evidence to aid clinicians in radiologically detecting Petersen's hernia.

We report a case of small bowel obstruction (SBO) caused by internal hernia from Meckel's diverticulum (MD). Abdominal CT scan showed an abnormal dilated blind-ending structure in continuity with the distal ileum in the right lower quadrant, suggesting Meckel's diverticulum. MPR images revealed a “double beak-sign” at the point of MD and a collapsed closed loop with mesenteric vessels converging to the diverticulum. Since the patient has no prior history of abdominal surgery, the diagnosis of internal hernia caused by Meckel's diverticulum was considered. On laparoscopic exploration, an abnormal orifice for internal hernia created by adhesion from the tip of Meckel's diverticulum to the adjacent mesentery was revealed, confirming the diagnosis. The patient was discharged after 7 days without postoperative complications. MD-associated internal hernia is a rare cause of small bowel obstruction and should be considered to avoid delay in treatment. Multidetector Computed Tomography (MDCT) is the first-line imaging modality of choice and may offer some suggestive imaging features to make an accurate preoperative diagnosis.

Abstract Background Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology. Case presentation We hereby report a rare case of a 66-year-old African American male patient who presented to the emergency department with complaints of acute gastrointestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed evidence of an internal hernia and surgical exploration revealed a hemorrhagic and infarcted omentum. Biopsies along with immunophenotypic studies confirmed the diagnosis of anaplastic T-cell lymphoma of the omentum complicated by Massilia timonae infection. Conclusion The case highlights the significance of considering lymphoma, although rare, as a differential in a patient who presents with small bowel obstruction and the importance of investigating for malignancy for early diagnosis and treatment of primary omental lymphomas, before complications develop.

Abstract Laparoscopic donor nephrectomy was introduced in 1995 as a means of minimally invasive surgeries that entail kidney extraction from healthy individuals. Since then, it has widely overtaken the traditional open surgical approaches, especially in live donor nephrectomy procedures worldwide. Laparoendoscopic single-site surgery is considered a more optimized surgical approach utilizing a single incision instead of four. Various studies have scrutinized many of the risk factors related to such surgeries, most commonly: vascular problems, intraoperative organ injury, and postoperative ileus. Other rare complications have not been thoroughly explored due to their decreased prevalence. Internal hernias are considered a rare complication of laparoendoscopic single-site surgery with dangerous repercussions ranging from bowel obstruction to ischemia, and necrosis. Our study presents a rare case of a trans-mesenteric internal hernia following laparoendoscopic single-site surgery. The patient was relatively healthy with no serious medical conditions. However, the past medical history did record a diagnosis of irritable bowel syndrome a few years back. Knowing that the occurrence of internal hernias is infrequent, we recommend that mesenteric defects be taken seriously to avoid the risk of internal hernias and their complications.

Introduction Petersen’s hernia is a rare and serious complication that can occur after radical gastrectomy and digestive tract reconstruction for gastric cancer. This article summarises the symptoms, diagnosis and treatment of Petersen’s hernia after surgery for gastric cancer. Patients and Methods A retrospective analysis was conducted on 11 male patients who were diagnosed with Petersen’s hernia and underwent surgical treatment at our hospital from January 2020 to December 2022. Their clinical manifestations, perioperative conditions and follow-up after treatment were collected. Results The median age was 58.5 years (range: 45–73), and the median time since gastrectomy was 24 months (range: 4–125). Open distal gastrectomy (45.5%) and open total gastrectomy (27.3%) were the most common procedures. Roux-en-Y (81.8%) was the predominant anastomosis method. All patients underwent emergency surgery within a median time of 30 h (range: 4–45). Intestine necrosis occurred in 36.4% of cases, with a perioperative death rate of 27.3%. Conclusion Petersen’s hernia after gastric cancer surgery can quickly lead to necrotising intestinal obstruction and poor prognosis. Enhanced abdominal computed tomography should be performed as soon as possible, and early exploratory laparotomy should be done to avoid intestinal necrosis. Routine closure of the mesenteric defect after gastric cancer resection can prevent the occurrence of Petersen’s hernia. This article highlights the need for increased awareness and preventive measures to minimise the occurrence of Petersen’s hernia in gastric cancer patients. It emphasises the importance of early detection and appropriate management strategies for improved patient outcomes.

Background: Caecal volvulus in the paediatric population is uncommon, yet at worst this condition is a life‐threatening surgical emergency. In children, caecal volvulus can be associated with a variety of predisposing factors such as chronic constipation, intestinal malrotation, or neurological disease. Case Representation: We present a rare case of caecal volvulus, internal hernia, and an intestinal rotational abnormality in a previously healthy 8‐year‐old boy. The patient presented with a history of abdominal pain and vomiting for 3 days and was admitted to the hospital in a severe septic shock. After the initial stabilisation with fluids and vasopressors, an emergency laparotomy was performed. A necrotic caecum volvulus, a transmesocolic hernia, and an abnormal rotation of the small intestine were diagnosed. The necrotic bowel segment was resected in a right‐sided hemicolectomy, after which a resection distal to medial colic artery was cut‐off to achieve normal anatomy. The patient was discharged on the 12th postoperative day in good health and has since returned to normal active life without any health issues within the follow‐up of 5 months. Conclusions: Caecal volvulus and internal hernia can lead to a life‐threatening condition requiring immediate surgical treatment. Rare causes of abdominal pain in children should be kept in mind when severe symptoms are present. [ABSTRACT FROM AUTHOR]

Complications of acute pancreatitis can be disastrous if appropriate treatment is not initiated. Pancreatic necrosis can occur without the presence of symptoms; however, in some cases, it can be accompanied by organic failure, abscess, pseudocyst, fistulas, and pancreatic exocrine disfunction. The surgical treatment of pancreatic necrosis can be managed with open surgical debridement of necrotic tissue. Hence, complications after surgery can appear even in patients without clinical background; complications mostly appear if the surgical technique is not done properly. We present a case of a 47-year-old woman who appeared with abdominal pain, nausea, vomiting, and oral intake intolerance. Symptoms were present for 1 week; she was admitted to the nearest clinic, and surgical management was offered. The patient went to an open pancreatic necrosectomy; however, she presented purulent exudate from the surgical wound and drains. Was referred to our center; on abdominal contrasted computed tomography, a transmesenteric defect and cutaneous-pancreatic fistula were found. [ABSTRACT FROM AUTHOR]

Laparoscopic donor nephrectomy was introduced in 1995 as a means of minimally invasive surgeries that entail kidney extraction from healthy individuals. Since then, it has widely overtaken the traditional open surgical approaches, especially in live donor nephrectomy procedures worldwide. Laparoendoscopic single-site surgery is considered a more optimized surgical approach utilizing a single incision instead of four. Various studies have scrutinized many of the risk factors related to such surgeries, most commonly: vascular problems, intraoperative organ injury, and postoperative ileus. Other rare complications have not been thoroughly explored due to their decreased prevalence. Internal hernias are considered a rare complication of laparoendoscopic single-site surgery with dangerous repercussions ranging from bowel obstruction to ischemia, and necrosis. Our study presents a rare case of a trans-mesenteric internal hernia following laparoendoscopic single-site surgery. The patient was relatively healthy with no serious medical conditions. However, the past medical history did record a diagnosis of irritable bowel syndrome a few years back. Knowing that the occurrence of internal hernias is infrequent, we recommend that mesenteric defects be taken seriously to avoid the risk of internal hernias and their complications. [ABSTRACT FROM AUTHOR]

Background: Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology. Case presentation: We hereby report a rare case of a 66-year-old African American male patient who presented to the emergency department with complaints of acute gastrointestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed evidence of an internal hernia and surgical exploration revealed a hemorrhagic and infarcted omentum. Biopsies along with immunophenotypic studies confirmed the diagnosis of anaplastic T-cell lymphoma of the omentum complicated by Massilia timonae infection. Conclusion: The case highlights the significance of considering lymphoma, although rare, as a differential in a patient who presents with small bowel obstruction and the importance of investigating for malignancy for early diagnosis and treatment of primary omental lymphomas, before complications develop. [ABSTRACT FROM AUTHOR]

Background: Small mesenteric hiatal hernias (SMHHs) are defined as a small group of internal hernias (IHs) that frequently diagnosed in children. However, SMHHs are relatively rare in adults. Bowel loop herniation via an abnormal mesenteric defect can lead to strangulated intestinal obstruction. Congenital SMHHs are commonly observed in pediatric patients, with some cases involving neonatal death. Case presentation: A 24-year-old healthy male patient visited our hospital with a 2-day history of a sudden onset lower abdominal pain. He was initially diagnosed with enteritis. However, his symptoms worsened, and he was brought to our hospital. Contrast-enhanced computed tomography (CT) scan showed formation of a closed loop in the small intestine within the pelvis and signs of ischemia. As the patient was diagnosed with small bowel obstruction (SBO) caused by IH, emergency laparoscopic surgery was performed to loosen the obstruction. The patient was found to have ascites and small-bowel necrosis. A part of the small intestine that measured 30 cm was strangulated via a large-diameter defect (17 × 11 cm) in the ileal mesentery. Via a small abdominal incision, the necrotic bowel was resected, and the mesenteric defect was repaired. Conclusion: SMHHs are rare in adults, and they should be considered as potential causes of strangulated intestinal obstruction in adults without a history of laparotomy or trauma. [ABSTRACT FROM AUTHOR]

Transmesenteric internal hernia is an uncommon cause of small bowel obstruction that occurs when small bowel loops protrude through a mesenteric defect into the abdominal cavity. Herein, we present an unexpected case of colonoscopy-induced transmesenteric internal hernia. An 81-year-old male patient presenting with intermittent hematochezia and constipation had undergone a laparoscopic left nephrectomy for ureteral cancer. A colonoscopy was performed to identify the etiology of his symptoms. He complained of severe abdominal pain 2 h after the examination despite uneventful endoscopic procedures, including cold snare polypectomy. Contrast-enhanced computed tomography revealed a strangulated small bowel obstruction with a closed-loop formation outside the descending colon. The small bowel loop was incarcerated into the left retroperitoneal space. Emergency laparotomy detected small bowel loops that prolapsed into the nephrectomy pedicle via a descending mesenteric defect, developed during the laparoscopic left nephrectomy. The incarcerated small bowel was detached from the hernia and returned to its normal position, and the mesenteric defect was closed. He demonstrated an uneventful postoperative course, with no internal hernia recurrence after discharge. This case indicates the risk of transmesenteric internal hernia through inadvertently created mesenteric defects should be borne in mind, especially when performing colonoscopies in patients who underwent laparoscopic nephrectomies. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) and acquired diaphragmatic hernia (ADH) are secondary to a weakness or opening in the diaphragm. Both are types of internal hernia. The abnormality can range from a minor defect in the posterior edge of the diaphragm to the entire loss of it. CDH usually leads to lung hypoplasia associated with pulmonary hypertension and immaturity, as well as cardiac dysfunction. In ADH, pathophysiology is secondary to herniation and its pressure effects. We report a series of two cases of spontaneous ADH (SADH). Spontaneous acquired rupture of the diaphragm can occur after exercise, coughing, labor (delivery), or even without any significant preceding event. It is uncertain if SADH is caused by a preexisting weak region in the diaphragm, a loss of muscle coordination during vigorous exertion, or both. It is a potentially fatal surgical emergency requiring a high index of clinical judgment in the appropriate clinical setting. SADH acts mechanically by compressing the lung. It is an infrequent entity. This case series and review concisely illustrate the genesis, diagnosis, and treatment of spontaneous diaphragmatic hernia. [ABSTRACT FROM AUTHOR]

Internal hernia through the Treitz fossa following robotic pancreatoduodenectomy is a rare but potentially serious complication. In our review of 328 cases of robotic pancreatoduodenectomies, two patients (0.6%) required repeat surgery due to internal herniation of the entire small bowel through the Treitz fossa. This complication can present as afferent loop syndrome, with symptoms including nausea, vomiting, and abdominal distension, possibly leading to cholangitis and pancreatitis. Timely diagnosis and intervention are paramount, as conservative management often fails. Preventive measures involve closing the peritoneal defect in the Treitz fossa at the end of robotic pancreatoduodenectomy, particularly in lean patients with thin mesentery who are at increased risk of internal hernia due to increased mobility of the small bowel. This technical note elucidates the pathogenesis of Treitz hernia following robotic pancreatoduodenectomy and underscores the importance of closing the peritoneal breach to prevent this rare yet potentially serious complication. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains the most effective procedure to treat severe obesity with proven short- and intermediate-term benefits. The main goal is to describe the effects on weight and biochemical laboratory tests after long-term follow-up (11 years). Materials and Methods: A prospective cohort of adults with obesity treated with LRYGB between 2004 and 2010 in one center were studied. Patients with prior bariatric or upper digestive tract surgery, hiatal hernia >4 cm, alcoholism, or decompensated conditions were excluded. The study enrolled 123 patients, with a mean follow-up of 133±29 months and a 14% loss of participants. Results: The percentage of Total Weight Loss (%TWL) at one, five, and eleven years was 30.3±8.4%, 29.1±6.9%, and 23.4±7%, respectively. Of the patients, 61.3% (65/106) maintained a %TWL≥20 after eleven years. Recurrent Weight Gain (RWG) at five and eleven years was 2.6±11.4% and 11 ±11.5%, respectively. At the end of the follow-up, 31.1% (33/106) of patients had RWG≥15%. Hypercholesterolemia and hypertriglyceridemia improved in 85.7% (54/63) and 90.2% (7/61) of the cohort, respectively. Remission of diabetes occurred in 80% of this subgroup. Gallstones developed in 28% of patients, and bowel obstruction due to internal hernia occurred in 9.4%. Anemia due to iron deficiency appeared in 25 patients. Conclusion: After surgery, there is a significant and durable loss of weight, with a tendency for late Recurrent Weight Gain. Furthermore, the improvement in biochemical parameters is sustained over time, but surgery's adverse effects may appear later. [ABSTRACT FROM AUTHOR]

ABSTRACT Severe obesity is a global concern now, and bariatric surgery has been proven to be the best solution. Most candidates are women of reproductive age; therefore, an increasing number of pregnant women with the history of gastric bypass is noticed. A 33‐year‐old woman at 23 weeks' gestation with a twin pregnancy, with a history of bariatric surgery 2 years prior her pregnancy, presented to our hospital with small bowel necrosis due to internal hernia and intussusception, we proceeded to laparotomy and resection of the necrotic segment of the bowel. The patient underwent cesarean section on the 35 weeks of her pregnancy due to preterm labor and intra uterine growth retardation of the fetuses. Since the gravid uterus increases the intraabdominal pressure, the complications of bariatric surgery such as intussusception or internal hernia may occur even more frequently during pregnancy. Although computed tomography scan or ultrasound could assist clinicians for early diagnosis of complications, negative findings could not rule out small bowel obstruction; therefore, in a pregnant woman with persisting abdominal pain, obstipation, and vomiting, exploratory laparotomy or laparoscopy is mandatory. Pregnant women with a history of Roux‐en‐Y gastric bypass surgery (RYGB) should be considered high‐risk obstetric, and symptoms like ongoing abdominal pain, and vomiting should be taken as alarm sign for small bowel obstruction. Computed tomography (CT) scan is the modality of choice for detecting the small bowel obstruction, and is mandatory, taking into consideration the considerable harms to the fetus.

Internal herniation through the foramen of Winslow (FoW) is a rare, life-threatening diagnosis. We present a case of intestinal obstruction due to herniation of the ileum, cecum, appendix, and ascending colon through the FoW. We reduced the herniation using a small colotomy and preserved the entirety of the bowel. We closed the FoW and colotomy and secured the bowel to the lateral abdominal wall by suture cecopexy. Due to the rarity of this pathology, the literature remains unclear about the benefits of prophylactic measures, hence, we recommend continued reporting of cases and research on prophylactic measures. Further, our own treatment strategy outlined in this report may provide further insight into the misdiagnosis and management of FoW hernias. [ABSTRACT FROM AUTHOR]

Abstract Background The preservation of the left colic artery (LCA) has emerged as a preferred approach in laparoscopic radical resection for rectal cancer. However, preserving the LCA while simultaneously dissecting the NO.253 lymph node can create a mesenteric defect between the inferior mesenteric artery (IMA), the LCA, and the inferior mesenteric vein (IMV). This defect could act as a potential “hernia ring,” increasing the risk of developing an internal hernia after surgery. The objective of this study was to introduce a novel technique designed to mitigate the risk of internal hernia by filling mesenteric defects with autologous tissue. Methods This new technique was performed on eighteen patients with rectal cancer between January 2022 and June 2022. First of all, dissected the lymphatic fatty tissue on the main trunk of IMA from its origin until the LCA and sigmoid artery (SA) or superior rectal artery (SRA) were exposed and then NO.253 lymph node was dissected between the IMA, LCA and IMV. Next, the SRA or SRA and IMV were sequentially ligated and cut off at an appropriate location away from the “hernia ring” to preserve the connective tissue between the “hernia ring” and retroperitoneum. Finally, after mobilization of distal sigmoid, on the lateral side of IMV, the descending colon was mobilized cephalad. Patients’preoperative baseline characteristics and intraoperative, postoperative complications were examined. Results All patients’ potential “hernia rings” were closed successfully with our new technique. The median operative time was 195 min, and the median intraoperative blood loss was 55 ml (interquartile range 30–90). The total harvested lymph nodes was 13.0(range12−19). The median times to first flatus and liquid diet intake were both 3.0 days. The median number of postoperative hospital days was 8.0 days. One patient had an injury to marginal arterial arch, and after mobolization of splenic region, tension-free anastomosis was achieved. No other severe postoperative complications such as abdominal infection, anastomotic leakage, or bleeding were observed. Conclusions This technique is both safe and effective for filling the mesenteric defect, potentially reducing the risk of internal hernia following laparoscopic NO.253 lymph node dissection and preservation of the left colic artery in rectal cancer surgeries.

Abstract Introduction To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. Methods A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. Results Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with “cross sign” as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. Discussion IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.