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Internal herniation (IH) is a common problem after laparoscopic Roux-en-Y gastric bypass surgery (RYGB). Routine closure of the mesenteric defects (MDs) reduces the risk of IH. Only very few articles report on risk factors for IH or describe detailed closing techniques. There is no consensus yet on the best closing method. The objective of this study is to determine the optimal stapling method for closure of MDs after RYGB. All performed RYGB procedures in our high-volume bariatric institute were included. Quality of the closure was scored in the categories poor, sub-optimal, and optimal, to see if the quality of the closure would predict the chance of reopening of the MDs and, therefore, the chance of IH. During any type of laparoscopy in the follow-up of the patient, the conditions of the MDs were stated, for example during diagnostic laparoscopy in symptomatic patients suspicious for IH or during laparoscopic cholecystectomy. Technically well-executed closure of Petersen's space (PS) with two rows of staples had a greater chance of still being closed upon re-inspection compared to closure with one row (odds ratio = 8.1; 95% confidence interval [1.2–53.2], p = 0.029). Optimal closure of the MD at the jejuno-jejunostomy (JJ-space, JJS) resulted in more closed JJSs upon re-inspection compared to sub-optimal closure (odds ratio = 3.6 [CI 95% 0.8–16.1], p = 0.099). Non-optimally closed MDs had higher reopening rates and, therefore, pose an additional risk for IH. Our classification provides a quality assessment of MD closure during RYGB and gives insight into how to optimize surgical technique. [ABSTRACT FROM AUTHOR]

Postoperative ileus is a common complication in patients with gastric cancer (GC). However, previous studies have mostly focused on its prevalence and other characteristics; research on its severity and risk factors remains limited. Therefore, this study aimed to create a nomogram for predicting postoperative complete ileus in patients with gastric cancer in order to provide better guidance for its diagnosis and treatment. The research population consisted of 173 patients admitted to Northern Jiangsu People's Hospital from January 2015 to October 2022, with 68 cases of partial intestinal obstruction and 105 cases of complete intestinal obstruction following radical gastrectomy. The risk factors for postoperative complete ileus were identified using univariate and multivariate regression analysis. The results showed that unclosed mesenteric defects (p = 0.046), postoperative metastasis (p = 0.029), and postoperative hypochloremia (p < 0.001) were independent risk factors for postoperative complete ileus. Based on these factors, we created a nomogram to predict the occurrence of postoperative complete ileus. This novel nomogram could serve as a crucial early warning indicator that would guide doctors to make informed decisions while managing patients with gastric cancer. [ABSTRACT FROM AUTHOR]

BackgroundInternal hernias through mesenteric defects are rare, particularly in the context of twin pregnancies, and can lead to severe complications such as bowel obstruction and strangulation. Early diagnosis is critical, yet challenging, due to the overlapping symptoms with other abdominal conditions and the limited use of advanced imaging during pregnancy.Case descriptionWe present a 33-year-old woman with a twin pregnancy at 33 + 2 weeks of gestation who experienced acute bowel obstruction due to an internal hernia through a congenital mesenteric defect. The patient presented with persistent upper abdominal pain, nausea, and vomiting. Given the advanced stage of pregnancy and the associated risks, a cesarean section was performed, followed by surgical exploration. Approximately one meter of strangulated small intestine was resected, and the mesenteric defect was repaired. Both mother and infants recovered uneventfully.ConclusionThis case highlights the importance of considering internal hernia in the differential diagnosis of acute abdominal pain during pregnancy. Prompt surgical intervention is crucial to prevent maternal and fetal morbidity.

An 8-month-old castrated male British Shorthair cat presented with acute anorexia and vomiting. The overall clinical presentation included generalized depression. Physical examination revealed palpable abdominal mass, thus foreign body or intussusception was suspected. Abdominal radiographs showed segmental dilation of small intestine and ultrasonography revealed target lesion with dilated small bowel loops and disrupted normal wall layering, suggestive of intussusception. Exploratory laparotomy confirmed congenital mesenteric defects associated with small intestinal obstruction. Surgical intervention involved dissection, ligation of encircling blood vessels, and closure of mesenteric defects. The cat was discharged after 3 days, exhibiting normal postoperative recovery. To our knowledge, this is the first case report of congenital mesenteric defect associated with small intestinal obstruction in a cat. While internal hernias are rare, it is essential to include them in the differential diagnosis for cases of intestinal obstruction, particularly in patients with no history of previous surgery or trauma. The potential for strangulation and ischemia in the affected loops elevates internal hernias to a critical, lifethreatening condition, emphasizing the need for prompt recognition and urgent surgical intervention as an emergency. [ABSTRACT FROM AUTHOR]

Objective Laparoscopic colectomy has gained acceptance as a standard treatment for benign and malignant colorectal disease, such as diverticular disease and cancer, among others. Same as in open surgery, the laparoscopic approach carries a low risk of small bowel obstruction in the postoperative period, but in laparoscopic surgery, internal hernia after laparoscopic left colectomy may be a cause of small bowel obstruction with a significant risk of morbidity and mortality. This rare complication may be prevented with routine closure of the mesenteric defects created during the colectomy. Methods We present four cases of internal herniation after laparoscopic colectomy. Two cases were after laparoscopic left colectomy and two after laparoscopic low anterior resection. All four cases had full splenic flexure mobilization. Routine closure of the mesenteric defect was not performed in the initial surgery. Results The four patients were treated by laparoscopic reintervention with closure of the mesenteric defect. In two of them, conversion to open surgery was necessary. One of the patients developed recurrent internal herniation after surgical reintervention with mesenteric closure of the defect. All patients were managed without need for bowel resection, and mortality rate was 0%. Conclusion Internal herniation after laparoscopic colorectal surgery is a highly morbid complication that requires prompt diagnosis and management and should be suspected in the early postoperative period. Additional studies with extended follow-up are required to establish recommendations regarding its prevention and management.

Introduction: Internal herniation through a congenital mesenteric defect is an exceptional cause of acute intestinal obstruction. It is usually diagnosed during surgery. We report a case of congenital transmesenteric internal hernia in a 7-year-old girl, without an acute intestinal obstruction syndrome. Case presentation: A 7-year-old girl with no previous medical history was admitted to our unit for sudden severe abdominal pain. No vomiting, no signs of trauma or infection. She was in good general condition. Physical examination showed slight abdominal distension, extensive pain and tenderness on palpation. Rectal examination revealed normal stools and no blood No evidence of an inflammatory response. Abdominal ultrasound revealed moderate ascites and no signs of ischemic bowel. After resuscitation, the child was taken to the operating room for emergency laparotomy. Under general anaesthesia, a median incision was performed. Exploration revealed an extensive ileal necrosis and a small bowel incarceration through a mesenteric defect with a narrow opening. Resection and end-to-end ileo-ileal anastomosis was performed. The remainder jejuno-ileal segment was approximately 200 cm long. At 6 months postoperatively, the child had gained weight steadily. No symptoms of short small bowel syndrome. Conclusion: Congenital internal transmesenteric hernia should be considered in cases of sharp abdominal pain in young children, even without signs of intestinal obstruction syndrome.

Internal hernias are a worrying complication from laparoscopic Roux-en-Y gastric bypass (LRGB), with potential small bowel necrosis and obstruction. An electronic database search of Medline, Embase, and Pubmed was performed. All studies investigating the internal hernia rates in patients whose mesenteric defects were closed vs. not closed during LRGB were analysed. Odds ratios were calculated to assess the difference in internal hernia rate. A total of 14 studies totalling 20,553 patients undergoing LRGB were included. Internal hernia rate (220/12,445 (2%) closure vs. 509/8108 (6%) non-closure) and re-operation for small bowel obstruction (86/5437 (2%) closed vs. 300/3132 (10%) non-closure) were reduced when defects were closed. There was no difference observed when sutures were used to close the defects compared to clips/staples. [ABSTRACT FROM AUTHOR]

Introduction: Congenital volvulus without a prenatal diagnosis of malrotation is an extremely rare cause of acute intestinal obstruction in the foetal and neonatal period with a high morbidity and mortality. The aim of this report is to describe prenatal imaging, pregnancy characteristics and clinical outcomes to identify a gold standard management approach for neonates affected by congenital volvulus through our experience with this case as well as a review of the literature. Case presentation: We describe an intrauterine case of volvulus without malrotation suspected by prenatal ultrasound at 28 weeks' gestation, with enlarged hyperechogenic loops without peristalsis in a 715g preterm boy born at 29 weeks' gestation. The discrepancy between the minimal clinical manifestations and the severity of intestinal pathology is highlighted. At explorative laparotomy following delivery, a congenital mesenteric defect was identified through which small bowel had herniated and volvulised, causing prenatal bowel dilatation and necrosis. The necrotic bowel was resected, and both an ileostomy and jejunostomy were created within 30 hours of birth. However, severe post-operative complications were encountered, which ultimately led to the newborn's death. Conclusion: Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. A high index of suspicion is required in cases of bowel dilatation, intestinal duplication or malrotation. Strict foetal follow up with serial ultrasound assessment and planned cesarean delivery are recommended. Multidisciplinary care is essential. Time of delivery and surgical intervention should be standardised to reduce the risk of neonatal mortality.

Crohn's disease is a chronic inflammatory bowel condition that frequently leads to complications such as strictures and bowel obstruction, often necessitating surgical intervention. Surgical approaches like ileocecectomy and right colectomy are commonly performed, with an ongoing debate about whether to close the mesenteric defect during these procedures to prevent internal hernias and small bowel obstruction. In this case, a 39-year-old male individual with longstanding Crohn's disease underwent robotic-assisted colon mobilization, ileocecectomy with Kono-S anastomosis, and gastrojejunostomy to address strictures. On postoperative day two, he developed nausea, vomiting, and abdominal distension. Imaging revealed a small bowel closed-loop obstruction, which prompted reoperation. Laparoscopy and exploratory laparotomy identified an internal hernia through the ileocolic mesocolon defect, which was repaired by closing the defect. The closure of the mesenteric defect has been shown to significantly reduce the risk of internal hernias and small bowel obstruction. Numerous studies indicate that leaving the defect open can increase the likelihood of these complications, which often necessitate additional surgery. Concerns about tension and ischemia following defect closure have not been substantiated when appropriate techniques are used. Although literature specific to procedures like Kono-S anastomosis is limited, general surgical evidence supports mesenteric defect closure to mitigate the risk of postoperative complications. Mesenteric defect closure during surgeries for Crohn's disease reduces the risk of internal hernias and other postoperative complications without significantly increasing other surgical risks. Routine closure is therefore recommended to enhance patient outcomes and reduce the need for further interventions., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Louis et al.)

Background: Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. Methods: Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. Results: Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001). Conclusions: Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect. [ABSTRACT FROM AUTHOR]

We report the case of a 55-year-old man with a surgical history of distal gastrectomy with Roux-en-Y reconstruction performed 3 years prior to the present episode. During the follow-up, a newly developed, rapidly growing intraabdominal mass was detected in the mesentery of the small intestine. Although the patient had been asymptomatic, surgical resection was planned with the suspicion of malignancy, especially lymph node recurrence of the gastric cancer, owing to its rapid growth. Laparotomy showed that the tumor was located in the mesentery of the small intestine near the Roux-en-Y limb, and due to the involvement of the feeding vessels to the Roux-en-Y limb, the anastomotic site was resected en bloc with the tumor, and the whole Roux-en-Y limb was reconstructed. The histopathological finding was compatible with desmoid-type fibromatosis of the mesentery of the small intestine. Here we report our case and discuss the previously reported literature, especially related to gastric cancer.

Abstract Background To observe if closing the mesenteric defect with absorbable sutures creates a safe adhesion compared to non-absorbable suture after Roux-en-Y gastric bypass. Methods Rats were randomly assigned to 5 experimental groups according to the different suture materials used in closing the mesenteric defects (Peterson’s space) after Roux-en-Y gastric bypass. Group A (control group), Group B (non-absorbable suture, Prolene suture), Group C (biological glue), Group D (non-absorbable suture, polyester suture) and Group E (absorbable suture). All rats were followed up for 8 weeks postoperatively and underwent laparotomy to observe the degree of adhesion and closure of the mesenteric defect. Results No significant difference was found in the decrease in food intake and body weight among all groups. No internal hernia (IH) occurred in any group. The mesenteric defects of Group A remained completely visible without any closure or adhesion. Multiple gaps were found between the Prolene suture and the mesentery along the suture line in Group B. The mesenteric defects of Group C were complete closed with multiple adhesions of the small intestine and the greater omentum. The mesenteric defects in both Group D and Group E closed completely. The average adhesion scores in Group A and Group B were 0 and 0.33 ± 0.52 respectively. The average adhesion score in group C (3.83 ± 0.41) was higher than the other groups (p

We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett’s esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Thus, laparoscopic exploration was performed. Intraoperatively, accumulation of chylous ascites accompanying the internal hernia through the jejunojejunostomy mesenteric defect was observed, which was successfully treated with laparoscopic hernia reduction and defect closure by sutures without intestinal resection. Here, we discuss the case and report that along with previous studies, our study suggests that chylous ascites might be a reliable sign of intestinal viability for herniated intestines.

Fetal intestinal volvulus is a medical emergency with potentially fatal consequences thus requires a high index of suspicion and prompt intervention. Echogenic dilated bowels, Whirlpool/Coffee bean signs, polyhydramnios, fetal anemia, fetal ascites with aperistalsis, nonreaasuring CTG are few important diagnostic signs. Mostly it has been described without associated malrotation,as segmental volvulus due to malfixation of gut with or without associated anaomalies such as meconium ileus, CDH, abdominal wall defects. We describe for the first time a case of 1.9kg female fetus detected to have intestinal volvulus associated with multiple ileal atresias and mesenteric defect. The fetus had classical Whirlpool sign, polyhydramnios and anemia, was delivered by emergency Ceasarian Section, post natally detected to have tense abdomen, confirmed Whirlpool sign on post natal USG, underwent emergency laparotomy, resection of necrotic ileal loops & I-C junction and Jejuno-Colic anastomosis. Child adapted to elemental feeding with 50cm of Jejunum without Ileo-cecal valve without shortbowel syndrome. Importance of multidisciplinary perinatal care, possible intrauterine vascular accident in pathogenesis of atresia and fetal volvulus has been emphasized in the case report.

Congenital internal hernia is a rare cause of bowel obstruction in adults and often presents with complications. A high index of suspicion, occasionally aided by appropriate radiological imaging, should lead to early surgical intervention and thus reduce morbidity and mortality. In this article, we describe a case of a 27-year-old man who presented with periumbilical and right lower quadrant pain. The patient who had undergone surgery for appendicitis was found to have an incidental mesenteric defect with herniating 30 cm-long small bowel segment on exploration. The mesenteric defect was repaired and the herniated bowel segment was reduced to prevent volvulus. The patient made an uneventful recovery.

Background: The comparative evidence regarding the outcomes of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass (LRYGB) is poorly understood. We aimed to compare the outcomes of closure versus non-closure of mesenteric defects in LRYGB for morbid obesity.Methods: We conducted a search of electronic information sources to identify all comparative studies investigating the outcomes of closure versus non-closure of mesenteric defects in patients undergoing LRYGB for morbid obesity. We used the Cochrane risk of bias tool and the ROBINS-I tool to assess the risk of bias of RCTs and observational studies, respectively. Random or fixed effects modelling was applied as appropriate.Results: We included 10,031 patients from six observational studies and 2609 patients from two RCTs. Analysis of observational studies showed closure defects resulted in lower risks of internal hernia (OR 0.28, 95% CI 0.15, 0.54) and reoperation for small bowel obstruction (SBO) (OR 0.30, 95% CI 0.10, 0.83); no difference was found between the two groups in terms of SBO not related to internal hernia (OR 1.19, 95% CI 0.47, 2.99), early SBO (OR 0.74, 95% CI 0.04, 14.38), anastomotic leak (OR 0.84, 95% CI 0.45, 1.57), bleeding (OR 1.08, 95% CI 0.62, 1.89), and anastomotic ulcer (OR 2.08, 95% CI 0.62, 6.94). Analysis of RCTs showed closure of defects resulted in lower risks of internal hernia (OR 0.29, 95% CI 0.19,0.45) and reoperation for SBO (OR 0.51, 95% CI 0.38, 0.69) but higher risks of SBO not related to internal hernia (OR 1.90, 95% CI 1.09, 3.34) and early SBO (OR 2.63, 95% CI 1.16, 5.96); no difference was found between the two groups in terms of anastomotic leak (OR 1.95, 95% CI 0.80, 4.72), bleeding (OR 0.67, 95% CI 0.38, 1.17), and anastomotic ulcer (OR 2.08, 95% CI 0.62, 6.94).Conclusions: Our results suggest that closure of mesenteric defects in LRYGB may be associated with lower risks of internal herniation and reoperation for SBO compared with non-closure of the defects (moderate certainty). The available evidence is inconclusive regarding the risks of SBO not related to internal hernia and early SBO (low certainty). More RCTs are needed to improve the robustness of the available evidence. [ABSTRACT FROM AUTHOR]

Background: To observe if closing the mesenteric defect with absorbable sutures creates a safe adhesion compared to non-absorbable suture after Roux-en-Y gastric bypass.Methods: Rats were randomly assigned to 5 experimental groups according to the different suture materials used in closing the mesenteric defects (Peterson's space) after Roux-en-Y gastric bypass. Group A (control group), Group B (non-absorbable suture, Prolene suture), Group C (biological glue), Group D (non-absorbable suture, polyester suture) and Group E (absorbable suture). All rats were followed up for 8 weeks postoperatively and underwent laparotomy to observe the degree of adhesion and closure of the mesenteric defect.Results: No significant difference was found in the decrease in food intake and body weight among all groups. No internal hernia (IH) occurred in any group. The mesenteric defects of Group A remained completely visible without any closure or adhesion. Multiple gaps were found between the Prolene suture and the mesentery along the suture line in Group B. The mesenteric defects of Group C were complete closed with multiple adhesions of the small intestine and the greater omentum. The mesenteric defects in both Group D and Group E closed completely. The average adhesion scores in Group A and Group B were 0 and 0.33 ± 0.52 respectively. The average adhesion score in group C (3.83 ± 0.41) was higher than the other groups (p<0.05). The average adhesion scores in Group D and E were similar (3.17 ± 0.41 and 3.00 ± 0.00 respectively).Conclusion: Absorbable suture created a safe adhesion score between the mesentery which was not inferior to non-absorbable sutures. [ABSTRACT FROM AUTHOR]

We report the case of a 55-year-old man with a surgical history of distal gastrectomy with Roux-en-Y reconstruction performed 3 years prior to the present episode. During the follow-up, a newly developed, rapidly growing intraabdominal mass was detected in the mesentery of the small intestine. Although the patient had been asymptomatic, surgical resection was planned with the suspicion of malignancy, especially lymph node recurrence of the gastric cancer, owing to its rapid growth. Laparotomy showed that the tumor was located in the mesentery of the small intestine near the Roux-en-Y limb, and due to the involvement of the feeding vessels to the Roux-en-Y limb, the anastomotic site was resected en bloc with the tumor, and the whole Roux-en-Y limb was reconstructed. The histopathological finding was compatible with desmoid-type fibromatosis of the mesentery of the small intestine. Here we report our case and discuss the previously reported literature, especially related to gastric cancer. [ABSTRACT FROM AUTHOR]

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Background: Internal hernia is a rare but a potentially fatal complication of laparoscopic Roux-En-Y gastric bypass (LRYGB). The aims of this study are to determine the impact of mesenteric defects closure on the incidence of internal hernia after LRYGB and to determine the symptoms, characteristics, and management of internal hernias after LRYGB. Methods: A retrospective study for a total of 2093 LRYGB was carried out from 1998 to December 2013. Four hundred twenty-one patients were operated without closure of the mesenteric defects (group A). From January 2005 to December 2013, 1672 patients were operated with closure of the mesenteric defects at Petersen defect (PD) and at jejunojejunal anastomosis (J-J) defect (group B). The incidence of internal hernias was compared between the two periods. Results: Out of the 2093 patients who underwent LRYGB, 20 patients (0.95%) developed a symptomatic internal hernia that required primary surgical intervention; 7 patients (1.66%) in group A all at J-J DEFECT versus 13 patients (0.78%) in (group B) 6 at (J-J DEFECT), 5 at PD, and 2 at PD, J-J DEFECT. This incidence was significantly lower in (group B) (p = 0.0021). The median interval between LRYGB and reoperation was 53 months in group A and 26 months in group B. A CT scan was performed in 8 patients, 40%, and showed signs of occlusion in all cases. Conclusions: The closure of mesenteric defects during LRYGB is recommended because it is associated with a significant reduction in the incidence of internal hernia. [ABSTRACT FROM AUTHOR]

Background: Although the internal hernia is rare after gastric cancer surgery, it is a serious complication, and prompt surgical treatment is essential. However, internal hernia has not been studied because of low incidence and difficulty of diagnosis. This study investigated the clinical characteristics and proper management of internal hernia after gastrectomy.Methods: From June 2001 to June 2016, patients who underwent gastrectomy, either open or laparoscopic (robotic) surgery, with potential internal hernia defect were enrolled. The hernia defect was not closed in any of the enrolled patients. The clinicopathological data of internal hernia patients were compared to patients without internal hernia to identify risk factors. Surgical outcomes of internal hernia were compared between patients who underwent early and late intervention group according to time interval from symptom onset to operation.Results: Of 5777 patients who underwent gastrectomy with possible internal hernia, 24 (0.4%) underwent emergency or scheduled surgery for internal hernia. Internal hernia through the Petersen space was observed in 15 cases, and through the jejunojejunostomy mesenteric defect in 9 cases. Low body mass index (odds ratio [OR] 4.403, p = 0.003) and laparoscopic approach (OR 6.930 p < 0.001) were statistically significant factors in multivariate analysis. Postoperative complication rate (16.7% vs. 50% p = 0.083) and mortality rate (8.3% vs. 25.0% p = 0.273) were slightly higher in the late intervention group.Conclusions: Although internal hernia is a rare complication, it is difficult to diagnose and cause serious complications. To prevent internal hernia, the necessity of hernia defect closure should be investigated in the further studies. Early surgical treatment is necessary when it is suspected. [ABSTRACT FROM AUTHOR]

A 39-year-old female presented with a history of recurrent pain abdomen for 2 years. The pain was colicky and intermittent in nature. She had been diagnosed to have right-sided nephrolithiasis based on the findings of computed tomography (CT) abdomen and was managed conservatively during each episode of pain. During the present episode, her pain started 4 days prior to presentation and was associated with vomiting and inability to pass stool and flatus. X-ray abdomen showed evidence of dilated bowel loops. On clinical examination, her abdomen was distended with tenderness and guarding in the right lower abdomen. Her CT abdomen revealed dilated ileal loops in the right lower abdomen. The distal bowel was found to be collapsed. On exploratory laparotomy, a volvulus of the distal ileum, caecum and part of ascending colon was noted. The involved bowel loops were gangrenous. A mesenteric defect of about 10 cm was noted in the root of the mesentery, which had caused an internal herniation, volvulus and gangrene. She underwent a right hemicolectomy with covering ileostomy. Congenital mesenteric defects leading to internal herniation are a well-documented condition in pediatric population. Although the same can occur in adults, it is an infrequent cause of intestinal obstruction.

Paraduodenal hernias, particularly those on the right side, are rare but clinically significant occurrences characterized by the abnormal protrusion of abdominal contents through mesenteric defects adjacent to the duodenum. These hernias result from embryologic malformations and can lead to complications such as intermittent abdominal pain, nausea, and, in severe cases, bowel obstruction. This case describes a 48-year-old male who presented with a 24-hour history of colicky abdominal pain in the right upper quadrant, associated with nausea. Further investigation, including a computed tomography scan, revealed a right paraduodenal hernia with herniation of small bowel loops through a mesenteric defect. Timely surgical intervention via laparoscopic exploration confirmed the diagnosis and facilitated the reduction of herniated bowel, followed by meticulous repair of the mesenteric defect using nonabsorbable sutures. The patient's recovery was uneventful, with a return to normal bowel function, and postoperative follow-up showed the resolution of symptoms. This case underscores the clinical complexity and management challenges associated with right paraduodenal hernias. Surgical intervention, guided by laparoscopic exploration, emerged as an effective and minimally invasive approach. The successful reduction of herniated small bowel loops and meticulous closure of the mesenteric defect contributed to a favorable postoperative course, highlighting the importance of timely intervention to prevent complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alblowi et al.)

Introduction: Transmesenteric hernia (TH) is an extremely rare cause of bowel ischaemia in adults with few reported cases. Case report: A 71-year-old man experienced six hours of severe epigastric abdominal pain, without signs of intestinal obstruction and with no history of abdominal surgery. In response to clinical deterioration, an emergency laparotomy was performed, revealing a 4 cm transmesenteric defect in the jejunal region. One hundred ninety centimeters of the small bowel were herniated through the defect and became gangrenous. The hernia was reduced, small bowel resected, and primary anastomosis performed. The patient recovered and was discharged ten days later. Discussion: Clinical symptoms, radiological imaging, and laboratory tests can be non-specific in the diagnosis of TH. The mortality rate is higher than 50 %. This paper summarizes the most important clinical traits based on a comprehensive literature review. Conclusion: Intestinal obstruction due to TH is a potentially lethal condition. The important clinical traits related to TH should be closely monitored. If there is no improvement or clinical deterioration occurs, it is mandatory to do early surgery to reduce morbidity and mortality.

Copyright of Medical Bulletin of Haseki / Haseki Tip Bulteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The purposes of the study are to outline the complexity of diagnosing internal herniation after Roux-en-Y gastric bypass (RYGB) surgery and to investigate the added value of computed tomography angiography (CTA) for diagnosing internal herniation.Materials and Methods: A cadaver study was performed to investigate the manifestations of internal hernias and mesenteric vascularization. Furthermore, a prospective, ethics approved study with retrospective interpretation was conducted. Ten patients, clinically suspected for internal herniation, were prospectively included. After informed consent was obtained, these subjects underwent abdominal CT examination, including additional arterial phase CTA. All subjects underwent diagnostic laparoscopy for suspected internal herniation. The CTA was used to create a 3D reconstruction of the mesenteric arteries and surgical staples (3D CTA). The 3D CTA was interpreted, taking into account the presence and type of internal hernia that was found upon laparoscopy.Results: Cadaveric analysis demonstrated the complexity of internal herniation. It also confirmed the expected changes in vascular structure and surgical staple arrangement in the presence of internal herniation. 3D CTA studies of the subjects with active internal hernias demonstrated remarkable differences when compared to control 3D CTA studies. The blood supply of herniated intestinal limbs in particular showed abnormal trajectories. Additionally, enteroenterostomy staple lines had migrated or altered orientation.Conclusion: 3D CTA is a promising technique for diagnosing active internal hernias. Our findings suggest that for diagnosing internal hernias, focus should probably shift from routine abdominal CT examination towards the 3D assessment of the mesenteric vasculature and surgical staples. [ABSTRACT FROM AUTHOR]

Background: The closure of the mesenteric defects (CMD) in Roux-en-Y gastric bypass (RYGB) reduces the risk of small bowel obstruction (SBO) due to internal hernia but might be associated with an increased risk of early SBO triggered by the jejunojejunal anastomosis (JJS) kinking. The aim of this study was to assess how enlarging the JJS with a bidirectional linear stapling can aid in avoiding the risk of early SBO by kinking.Materials and Methods: This retrospective cohort study concerns 1327 patients who underwent RYGB with CMD between May 2007 and August 2016. The first 626 patients (group A) had a unidirectional JJS. The following 701 patients (group B) had a bidirectional side-to-side JJS and a hand-sewn closure of the remaining defect. We compared early SBO between the two groups.Results: Eleven (1.75%) early SBO due to the JJS kinking occurred in group A, whereas none occurred in group B (p = 0.0012). Thirty-nine early postoperative complications happened in group A versus 32 in group B (p = 0.17). Nine (1.2%) digestive bleedings occurred in group B versus two (0.3%) in group A (OR = 4.05 [0.87-18], p = 0.054). Average operating time was 81 min [37-330] in group A and 77 min [33-240] in group B.Conclusion: Enlarging the JJS with a bidirectional linear stapling is associated with a reduced risk of early SBO due to the anastomosis kinking. However, it could be related to an increased risk of digestive bleedings. [ABSTRACT FROM AUTHOR]

Internal herniation through a congenital mesenteric defect is an exceptional cause of acute intestinal obstruction. It is usually diagnosed during surgery. We report a case of congenital transmesenteric internal hernia in a 7-year-old girl , without an acute intestinal obstruction syndrome. A 7-year-old girl with no previous medical history was admitted to our unit for sudden severe abdominal pain. No vomiting, no signs of trauma or infection. She was in good general condition. Physical examination showed slight abdominal distension, extensive pain and tenderness on palpation. Rectal examination revealed normal stools and no blood No evidence of an inflammatory response. Abdominal ultrasound revealed moderate ascites and no signs of ischemic bowel. After resuscitation, the child was taken to the operating room for emergency laparotomy. Under general anaesthesia, a median incision was performed. Exploration revealed an extensive ileal necrosis and a small bowel incarceration through a mesenteric defect with a narrow opening. Resection and end-to-end ileo-ileal anastomosis was performed. The remainder jejuno-ileal segment was approximately 200 cm long. At 6 months postoperatively, the child had gained weight steadily. No symptoms of short small bowel syndrome. Congenital internal transmesenteric hernia should be considered in cases of sharp abdominal pain in young children, even without signs of intestinal obstruction syndrome. [ABSTRACT FROM AUTHOR]

Internal herniation is a rare cause of intestinal obstruction, especially in the emergency department. We report a child with acute abdomen resulting from transmesenteric internal herniation of the small bowel. Radiographic findings revealed gaseous distension of the bowel loops in the upper abdominal area with a paucity of gas in the lower abdomen. Operative finding showed gangrenous small bowel due to mesenteric defect with an internal herniation. The gangrenous bowel was resected and the patient was discharged with an uneventful outcome. We emphasize that early recognition of internal herniation warrants further evaluation and appropriate management.

Congenital volvulus without a prenatal diagnosis of malrotation is an extremely rare cause of acute intestinal obstruction in the foetal and neonatal period with a high morbidity and mortality. The aim of this report is to describe prenatal imaging, pregnancy characteristics and clinical outcomes to identify a gold standard management approach for neonates affected by congenital volvulus through our experience with this case as well as a review of the literature. We describe an intrauterine case of volvulus without malrotation suspected by prenatal ultrasound at 28 weeks' gestation, with enlarged hyperechogenic loops without peristalsis in a 715g preterm boy born at 29 weeks' gestation. The discrepancy between the minimal clinical manifestations and the severity of intestinal pathology is highlighted. At explorative laparotomy following delivery, a congenital mesenteric defect was identified through which small bowel had herniated and volvulised, causing prenatal bowel dilatation and necrosis. The necrotic bowel was resected, and both an ileostomy and jejunostomy were created within 30 hours of birth. However, severe post-operative complications were encountered, which ultimately led to the newborn's death. Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. A high index of suspicion is required in cases of bowel dilatation, intestinal duplication or malrotation. Strict foetal follow up with serial ultrasound assessment and planned cesarean delivery are recommended. Multidisciplinary care is essential. Time of delivery and surgical intervention should be standardised to reduce the risk of neonatal mortality. [Display omitted] [ABSTRACT FROM AUTHOR]