Kaw P, Behari A, Sharma S, Kumar A, Singh RK. Internal hernia as a rare cause of small bowel obstruction: An insight from 13 years of experience. World J Clin Cases 2025; 13(7): 92254 [DOI: 10.12998/wjcc.v13.i7.92254]
Corresponding Author of This Article
Anu Behari, MBBS, MS, Professor, Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow 226014, UP, India. anubehari@yahoo.co.in
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2025; 13(7): 92254 Published online Mar 6, 2025. doi: 10.12998/wjcc.v13.i7.92254
Internal hernia as a rare cause of small bowel obstruction: An insight from 13 years of experience
Payal Kaw, Anu Behari, Supriya Sharma, Ashok Kumar, Rajneesh K Singh
Payal Kaw, Anu Behari, Supriya Sharma, Ashok Kumar, Rajneesh K Singh, Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
Author contributions: Kaw P collected the data, reviewed the literature, and contributed to conceptualization and manuscript writing; Behari A designed the research study, supervised the process of data collection and manuscript writing, and critically reviewed the study; Sharma S, Kumar A, and Singh RK were responsible for critical review of the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study was reviewed and granted an exemption.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: No additional information to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anu Behari, MBBS, MS, Professor, Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow 226014, UP, India. anubehari@yahoo.co.in
Received: January 20, 2024 Revised: September 21, 2024 Accepted: October 8, 2024 Published online: March 6, 2025 Processing time: 310 Days and 1.9 Hours
Abstract
BACKGROUND
Internal hernia (IH) is a rare culprit of small bowel obstruction (SBO) with an incidence of < 1%. It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis, improper treatment, and subsequent morbidity and mortality.
AIM
To determine the clinico-demographic profile, radiological and operative findings, and postoperative course of patients with IH and its association with SBO.
METHODS
Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow, India between September 2010 and August 2023 were reviewed.
RESULTS
Out of 586 patients, 7 (1.2%) were diagnosed with IH. Among these, 4 had congenital IH and 3 had acquired IH. The male-to-female ratio was 4:3. The median age at presentation was 32 years. Contrast-enhanced computed tomography (CECT) was the most reliable investigation for preoperative identification, demonstrating mesenteric whirling and clumped-up bowel loops. Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency (approximately 43% each). Intraoperatively, one patient was found to have bowel ischemia and one had associated malrotation of gut. During follow-up, no recurrences were reported.
CONCLUSION
IH, being a rare cause, must be considered as a differential diagnosis for SBO, especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery. A rapid imaging evaluation, preferably with CECT, is necessary to aid in an early diagnosis and prompt intervention, thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
Core Tip: Internal hernia (IH) represents less than 1% of all causes of small bowel obstruction. Being rare, IH poses a considerable diagnostic challenge. Contrast-enhanced computed tomography is the most reliable investigation for preoperative identification. A rapid imaging evaluation is necessary to aid in an early diagnosis and prompt intervention, thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel. Laparoscopic surgery is a safe option for uncomplicated IHs.
