Joana Ferrer (Hepatobiliary Surgery Senior Specialist)
Nils Hidalgo (Emergency Surgery Assistant Specialist)
Mario Pagès (Radiology Consultor)
Hospital Clínic, Barcelona – Spain
A 36 years old female with previous history of a uterine myoma and anemia, no surgical record, presented to the emergency department suffering from recurrent abdominal pain with one day of evolution.
At physical examination the abdomen was distended with localized pain at the left flank and iliac fossa. An X-Ray revealed dilated loops of small bowel, indicating the diagnosis of small bowel obstruction.
This is a case of a young female without previous surgical record so a CT Scan was performed to clarify the diagnosis. The scan showed a change of gauge of the small bowel, probably due to a mechanical cause.
Laparoscopic surgical revision was carried out requiring conversion to open approach because of the gut distention, the finding was an internal hernia causing a closed loop obstruction of the small bowel through a mesosigmoid defect (FIG 1).
Reduction of the internal hernia was accomplished, the small bowel was ischemic and perforated requiring resection plus manual end-to-end anastomosis. The mesosigmoid defect was closed with a running suture of VICRYL®.
Due to the preoperative condition she presented a progressive tolerance to the oral intake with a correct postoperative course. She left the hospital 10 days after the surgery.
Nine months after, she suffered from another episode of small bowel obstruction and underwent a laparotomy to take down the surgical adhesions.
No other medical episodes were present after 3 years of follow up.