THE BOWEL BEHIND THE CECUM: INTERNAL HERNIA CASE REPORT vania1999moreira@gmail.com

PE009

THE BOWEL BEHIND THE CECUM: INTERNAL HERNIA CASE REPORT

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Portugal

Poster Exhibition only

Internal hernias are rare (incidence of 0,6-5,8%), being an infrequent cause of small bowel obstruction. Paracecal hernias are the second most common type, developing with the small bowel protusion around the cecum or inside an orifice formed in the paracecal area. Diagnosis can be challenging due to the lack of specific findings. Surgery can be both diagnostic and curative.

An emergency department case report of a small bowel obstruction caused by a retrocecal hernia, including clinical, serological, imagiological and intra-operative findings.

86-year-old female presented with an acute abdomen. Laboratory analysis demonstrated increased inflammatory markers. Computed tomography scan showed a dilated small bowel with a caliber transition zone in the paracecal region and extraluminal air. Patient was submitted to emergency laparotomy, revealing a retrocecal recess orifice containing incarcerated and perforated ileum, with signs of ischemia. A segmental enterectomy was performed, followed by a primary anastomosis. Postoperative period was complicated with evisceration, that underwent surgical correction on the eleventh day. Patient was discharged fully recovered after fifteen days.

There are no clinical, laboratory or imagiological pathognomonic sings. Clinical symptoms of paracecal hernias are related to digestive obstruction, with abdominal pain, nausea, vomiting, and obstipation. Laboratory findings may include an increase in inflammatory markers when incarcerated or strangulated. Abdomino-pelvic computed tomography scan is the most useful imagiological test to identify the obstruction cause and location. Although it is rare, the only treatment for internal hernia is immediate surgery, and therefore surgeons should be aware of this pathology, when confronted with intestinal obstruction cases.