Internal hernia - a rare cause of small bowel obstruction: a case report

Samir U. Rambhia, Premjeet Madhukar


Internal hernia means a protrusion into pouches or openings in the peritoneum or mesentry in contrast to the hernias through defects in the retaining walls of the abdomen. Internal hernias are of many varieties with different classifications and can be congenital or acquired post-surgery. We present a case of a 55 year old female who presented with symptoms of acute small bowel obstruction with previous history of exploratory laparotomy 20 years back for reasons not known to her. Routine blood investigations, chest and abdomen skiagram and a CECT abdomen were performed (which gave no significant clue to diagnosis) and after a failed conservative trial patient was taken for exploration. Intra operatively a gangrenous loop of small bowel was found herniating through a band between the small bowel mesentry and the sigmoid mesocolon, forming a closed loop obstruction. Resection anastomosis of the gangrenous segment along with band transection was performed. The post-operative course was uneventful. Internal herniation as a cause of bowel obstruction should always be kept in mind as a differential.


Gangrenous bowel, Internal hernia, Small bowel obstruction

Full Text:



Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186:703-17.

Blachar A, Federle MP, Dodson SF Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology. 2001;218:68-74.

Al-khyatt W, Aggarwal S, Birchall J, Rowlands TE Acute intestinal obstruction secondary to left paraduodenal hernia: a case report and literature review. World J Emerg Surg. 2013;8:5.

Al-Mansour MR, Mundy R, Canoy JM, Dulaimy K, Kuhn JN, Romanelli J. Internal hernia after laparoscopic antecolic roux-en-y gastric bypass. Obes Surg. 2015;25(11):2106-11.

Blachar A, Federle MP, Brancatelli G, Peterson MS, Oliver JH, Li W. Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology. 2001;221(2):422-8.

Ozenç A, Ozdemir A, Coskun T. Internal hernia in adults. Int Surg. 1998;83(2):167-70.

Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV, Senthilkumar K. Laparoscopic management of paraduodenal hernias: mesh and mesh-less repairs. A report of four cases. Hernia. 2008;12(6):649-53.