Concealed cause, critical consequences: Internal hernias and small bowel obstruction
DOI:
https://doi.org/10.71152/ajms.v16i5.4453Keywords:
Internal hernia; Laparotomy; Bowel obstruction; Contrast computed tomography abdomenAbstract
Background: Internal hernias are potentially devastating condition that can manifest as intestinal obstruction and often present with nonspecific symptoms. This vagueness can lead to delayed diagnosis and management challenges. Therefore, clinical vigilance, prompt recognition, and timely intervention are crucial in preventing catastrophic complications associated with this under-recognized condition.
Aims and Objectives: The objective is to underscore the imperative of prompt diagnostic interventions in patients presenting with intestinal obstruction. Moreover, fostering awareness among nascent surgeons regarding this clinical entity is essential, as it can precipitate a paradigm shift in the long-term prognosis.
Materials and Methods: A retrospective analysis of data extracted from the emergency operative room register at GMC Thrissur, spanning a 5-year period.
Results: Sixteen cases underwent emergency laparotomy, with internal hernias diagnosed either preoperatively through contrast-enhanced imaging or encountered intraoperatively as an unexpected finding. Conversely, two patients underwent elective laparotomy. For all patients, the hernia was reduced and internal defect repaired. Six patients had the need for resection of gangrenous bowel segment with primary anastomosis, while none required the need for ileostomy. Post-operative period for all of the patients was uneventful.
Conclusion: The non-specific nature of clinical presentations inherent to internal hernias renders diagnosis exceedingly challenging. Prompt surgical intervention and early detection remains the sole viable treatment modality for this pathology. Early diagnosis is significantly facilitated by a comprehensive understanding and awareness of this rare yet formidable cause of intestinal obstruction. This cognizance serves as a catalyst for expedited decision-making and action, thereby playing a pivotal role in mitigating complications and profoundly influencing the outcome.
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