Laparoscopic treatment of a pericaecal internal hernia

Abstract

We present the case of a pericaecal hernia treated successfully with a laparoscopic approach and full recovery after surgery. A 53-year-old female patient with a personal history of depression, osteoporosis and irritable bowel syndrome consulted to the emergency department for abdominal pain and distension in the last 12 h, associated with one episode of vomit and diminished frequency in the passage of stools. The right abdomen was tender to palpation, and blood work revealed no leucocytosis. A computed tomography scan showed small bowel loops distended and displaced to the right parietocolic recess, lateral to the ascending colon. Exploratory laparoscopy was performed confirming the presence of small bowel loops incarcerated in the paracaecal fossa. These ones were reduced with gentle manoeuvres, and the peritoneal folds incised to prevent recurrence. The patient was started on an oral diet 2 days after surgery and discharged home on the 3^rd post-operative day.

Keywords: Internal hernia; laparoscopy; paracaecal hernia; pericaecal hernia; small bowel obstruction.

Figure 1

Abdominal X-ray. (a) Coronal view of computed tomography scan showing grouped loops lateral to caecum-ascending colon. (b) Axial view of computed tomography scan with distended loops in RLQ

Figure 2

(a) Laparoscopy showing incarcerated loops with signs of ischaemia. (b) Peritoneal folds covering bowel loops