Lesser omental hernia without intestinal gangrene - Case report.

INTRODUCTION: There are several types of internal hernia. Herniation through the defect in the lesser omentum is extremely rare. Symptoms of this type of hernias may vary a lot and diagnosis is difficult. In this case report a young adult with nonspecific symptoms is diagnosed with an intestinal herniation through the defect in the lesser omentum. CASE PRESENTATION: A 35-year-old man with the history of laparoscopic colectomy presented with abdominal pain but no symptoms of peritonitis or acute bowel obstruction. Abdominal computed tomography (CT) revealed displacement of mesenteric vessels, small intestine and stomach. Intestinal herniation through the lesser omentum was suspected. Laparoscopic reposition of small intestine was performed. The greater curvature of the stomach was sutured to the transverse mesocolon to prevent recurrence of hernia. DISCUSSION: Previous surgery, low body mass index (BMI), absence of adhesions may predispose the lesser omental hernia. Herniating of intestines through the large openings may occur without presence of acute obstruction or gangrene. CT is helpful in making a correct diagnosis. CONCLUSION: When evaluating the patient with abdominal pain, internal hernia should be considered. CT modalities may aid in the detection of these rare hernias and ensure timely treatment. Perioperative inspection and repair of the hepatogastric ligament may help to prevent lesser omental hernias.

Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study.

BACKGROUND: The aim of this retrospective study was to evaluate the peri-operative and long-term outcome after early repair with a hepaticojejunostomy (HJ). METHODS: Between 1995 and 2010, a nationwide, retrospective multi-centre study was conducted. All iatrogenic bile duct injury (BDI) sustained during a cholecystectomy and repaired with HJ in the five Hepato-Pancreatico-Biliary centres in Denmark were included. RESULTS: In total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Post-operative morbidity was 36% and mortality was 4%. Forty-two patients (30%) had a stricture of the HJ. The median follow-up time without stricture was 102 months. Nineteen out of the 42 patients with post-reconstruction biliary strictures had a re-HJ. Twenty-three patients were managed with percutaneous transhepatic cholangiography and dilation. The overall success rate of re-establishing the biliodigestive flow approached 93%. No association was found between timing of repair, concomitant vascular injury, level of injury and stricture formation. CONCLUSION: In this national, unselected and consecutive cohort of patients with BDI repaired by early HJ we found a considerable risk of long-term complications (e.g. 30% stricture rate) and mortality in both the short- and the long-term perspective.

[Complicated course after conservative treatment of incarcerated inguinal hernia]. / Kompliceret forløb efter konservativ behandling af indeklemt lyskebrok.

We report a case of intestinal perforation due to manual reduction of incarcerated inguinal hernia. Explorative laparotomy was delayed and first attempted after 21 hours. The patient died as a result of peritonitis. If conservative treatment of incarcerated inguinal hernia is considered, this should be done with caution. When successful, possibility of reduction of non-vital organ should be eliminated. Patient must be informed about symptoms and risks, otherwise hospitalisation can be considered.