1/4. Inguinal mass due to an external supravesical hernia and acute abdomen due to an internal supravesical hernia: a case report and review of the literature.Although supravesical hernias were described as early as 1804, there have been fewer than 100 cases reported in the literature. The supravesical fossa is a triangular area bounded laterally and above by median and medial umbilical ligaments, and below by the peritoneal reflection that passes from the anterior abdominal wall to the dome of the bladder. A hernia starting in this fossa usually protrudes through the abdominal wall as a direct inguinal hernia (external supravesical hernia). Less commonly, it remains within the abdomen, passing into spaces around the bladder (internal supravesical hernia). A 43-year-old mill worker presented with an enlarged painful mass in the left groin. He underwent a surgical repair of a direct inguinal hernia without addressing an unrecognized supravesicular component. Eight hours after his discharge next morning, he presented with acute abdomen, nausea, vomiting, and abdominal distention. The second surgery revealed the presence of a left lateral internal supravesical hernia with incarcerated small bowel. This was also repaired, and the patient was discharged in stable condition. This report aims to review and discuss the surgical anatomy of these rare supravesical hernias and calls attention to this type of hernia as an unusual cause of small bowel obstruction.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/4. Laparoscopic management of an internal double omental hernia: a rare cause of intestinal obstruction.INTRODUCTION: Internal hernia is a very rare cause of intestinal obstruction (0.2-0.9% of cases), associated with 45% mortality. A review of the literature revealed just eight reported cases of double omental hernia since 1950 of which our patient is the first case successfully treated laparoscopically. CASE PRESENTATION: We report on a 29-year-old man who presented with signs and symptoms of intestinal obstruction. The patient underwent emergent exploratory laparoscopy. This revealed herniation of a 20-cm jejunal loop through the gastrocolic ligament and reemergence through a defect in the gastrohepatic ligament. The strangulated loop was reduced with slight traction, and the defect was repaired. The patient was discharged from hospital in just 5 days' time, and after 6 months of follow-up, the general condition of the patient was normal. CONCLUSIONS: laparoscopy is a good technique with minimal complications compared with laparotomy. As many cases are missed due to nonspecific signs and symptoms, an urgent laparoscopy or laparotomy is highly recommended in such a situation.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
3/4. Strangulated hernia through a defect of the broad ligament and mobile cecum: a case report.We report a case of 28-year-old woman presenting with small bowel obstruction.She had neither prior surgery nor delivery.An upright abdominal radiograph revealed several air-fluid levels in the small bowel in the midabdomen and the pelvic cavity. Computed tomography demonstrated a dilated small bowel loop in the Douglas's fossa,but no definite diagnosis could be made. Supportive therapy with draining the intestinal fluid by a long intestinal tube did not result in improvement,which suggested the possibility of a strangulated hernia. Exploratory laparotomy revealed mobile cecum and a 20-cm length of the ileum herniated into a defect of the right broad ligament.As a gangrenous change was recognized in the incarcerated bowel, its resection was carried out,followed by end-to-end anastomosis and closure of the defects of the broad ligament. The postoperative course was uneventful. intestinal obstruction is a very common cause for presentation to an emergency department,while internal hernia is a rare cause of obstruction. Among internal hernias, those through defects of the broad ligament are extremely rare. Defects of the broad ligament can be either congenital or secondary to surgery, pelvic inflammatory disease,and delivery trauma. In conclusion, we emphasize that hernia of the broad ligament should be added to the list of differential diagnosis for female patients presenting with an intestinal obstruction. early diagnosis and surgical repair reduce morbidity and mortality from strangulation.- - - - - - - - - - ranking = 9keywords = ligament (Clic here for more details about this article) |
4/4. Internal hernia through the broad ligament presenting with acute on chronic intestinal obstruction: A case report.BACKGROUND: Internal hernias are rare. Their occurrence through the broad ligament is one of the rarest forms. We present a report of a 45 year Nigerian female with acute on chronic intestinal obstruction due to an internal hernia of the broad ligament. methods: patients case notes and a review of relevant literature using manual library and medline search was used. RESULTS: A 45-year-old multiparous woman presented with a ten-year history of features of partial intestinal obstruction, and no previous abdominal surgery. Examination revealed right iliac fossa tenderness and a plain abdominal radiograph showed air fluid levels. Conservative management was not successful and laparatomy confirmed an internal hernia of the right broad ligament which was repaired with satisfactory outcome. CONCLUSION: This report is to highlight the fact that though rare, internal hernia should be considered in the differential diagnosis of intestinal obstruction.- - - - - - - - - - ranking = 7keywords = ligament (Clic here for more details about this article) |