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Case Reports
. 2020 Mar 2;2020(3):rjaa008.
doi: 10.1093/jscr/rjaa008. eCollection 2020 Mar.

A rare case of a closed loop obstruction due to epiploic appendage of the sigmoid colon

Rathin Gosavi  1 , Ee Ban  1
Affiliations
Case Reports

A rare case of a closed loop obstruction due to epiploic appendage of the sigmoid colon

Rathin Gosavi et al. J Surg Case Rep. .

Abstract

An internal hernia is a protrusion of viscera through a congenital or acquired defect in the mesentery of peritoneum. They account for <0.9% of all small bowel obstructions [1] and ~4% of obstructions due to hernias [2]. We present a rare case of closed loop obstruction secondary to a band adhesion traversing the lower abdomen from a sigmoid colon appendage epiploicae to the right pelvic wall. A 82-year-old woman presented to the emergency department with nausea, vomiting and worsening right sided abdominal pain for 24 h, on the background of previous pelvic radiation and hysterectomy for uterine cancer. She was subsequently found to have a closed loop obstruction with 30 cm of ischemic bowel strangulated by a band adhesion from a sigmoid colon appendage epiploicae to the right abdominal wall. The patient underwent a successful small bowel resection with primary anastomosis and made an uneventful recovery.

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Figures

Figure 1
Figure 1
CT axial (a) and coronal (b) views showing loop of strangulated small bowel with surrounding fat stranding and free fluid (red arrows).
Figure 2
Figure 2
(a) Intraoperative image demonstrating loop of strangulated small bowel (red border) and band adhesion to the right pelvic wall (green border and arrow); and (b) schematic depiction of the closed loop obstruction.
See this image and copyright information in PMC

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