ABSTRACT
ABSTRACT Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.
ABSTRACT
Obturator hernia is an extremely rare pelvic hernia which occurs mostly in elderly, thin, multiparous women. Clinical manifestations are abdominal pain and/or unexplained intestinal obstruction, and obturator neuralgia due to compressed obturator nerve. As the lack of specific symptoms and external masses likes other abdominal wall hernias, its diagnosis may be arduous and difficult; hence, an accurate preoperative diagnosis or surgical treatment is often delayed, such a delay often leads to gangrenous bowel in a large proportion of cases and results in unacceptably high morbidity and mortality. preoperative detection of the obturator hernia due to clinical alert and in-time computed tomography of the pelvis. Early diagnosis and prompt initiation of surgical intervention are essential for this rare entity. This explanatory review emphasizes and illuminates its various facets under the significant events, anatomy, epidemiology and rationale of its diagnosis and management to familiarize surgeons with the condition that seldom thought of and hence seldom sought.
ABSTRACT
Obturator hernia is an extremely rare pelvic hernia which occurs mostly in elderly,thin,multiparous women.Clinical manifestations are abdominal pain and/or unexplained intestinal obstruction,and obturator neuralgia due to compressed obturator nerve.As the lack of specific symptoms and external masses likes other abdominal wall hernias,its diagnosis may be arduous and difficult;hence,an accurate preoperative diagnosis or surgical treatment is often delayed,such a delay often leads to gangrenous bowel in a large proportion of cases and results in unacceptably high morbidity and mortality,preoperative detection of the obturator hernia due to clinical alert and in-time computed tomography of the pelvis.Early diagnosis and prompt initiation of surgical intervention are essential for this rare entity.This explanatory review emphasizes and illuminates its various facets under the significant events,anatomy,epidemiology and rationale of its diagnosis and management to familiarize surgeons with the condition that seldom thought of and hence seldom sought.
ABSTRACT
Objetivos: descrever a história, o diagnóstico e o tratamento de uma paciente com hérnia obturadora.Descrição do caso: uma paciente de 71 anos apresentou quadro de abdome agudo obstrutivo secundário a uma hérnia obturadora encarcerada e recidivada. O diagnóstico foi feito pela tomografia computadorizada e o tratamento foi cirúrgico, através da correção do defeito com colocação de tela de polipropileno em forma de cone.Conclusões: a hérnia obturadora é uma rara mas importante causa de obstrução intestinal. Por ser uma patologia incomum, seu diagnóstico normalmente é tardio, sendo realizado no transoperatório ou, menos frequentemente, através de tomografia computadorizada em avaliação pré-operatória de abdome agudo. Existem diversas formas para sua correção cirúrgica.
Aims: To describe the history, diagnosis and treatment of a patient with obturator hernia.Case description: A 72 years old woman presented with acute obstructive abdomen secondary to an incarcerated recurrent obturator hernia. The diagnosis was made by computed tomography and the treatment was surgical, by repairing the defect with placement of a polypropylene mesh in a cone shape (patch/plug).Conclusions: Obturator hernia is a rare, but important cause of intestinal obstruction. Because it is an uncommon patology, the diagnoses is usually delayed and is done during surgery or, less frequently, by computed tomography in the preoperative evaluation of acute abdomen. There are several strategies for its surgical correction.