Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 16;9(1):178.
doi: 10.1186/s40792-023-01746-0.

A case of internal hernia in the pararectal fossa

Kozue Matsuishi  1 , Seiya Saito  1 , Mayuko Ohuchi  1 , Yuki Kiyozumi  1 , Jiro Nasu  1 , Norihisa Hanada  2 , Hideo Baba  3
Affiliations

A case of internal hernia in the pararectal fossa

Kozue Matsuishi et al. Surg Case Rep. .

Abstract

Background: Internal hernias are relatively rare and difficult to diagnose. Diagnostic delays lead to the progression of strangulation. In particular, pararectal fossa hernias are extremely rare. We encountered a case in which internal hernia occurred in the pararectal fossa.

Case presentation: An 87-year-old woman was referred to our hospital because of persistent lower abdominal pain and vomiting. Contrast-enhanced computed tomography revealed findings of intestinal ischemia, such as closed loop formation with reduced contrast effect on the left side of the rectum in the pelvis. Strangulation small bowel obstruction was diagnosed, and emergency laparotomy was performed. The small intestine was found to invade the peritoneal reflection on the left side of the rectum. The patient was finally diagnosed with pararectal fossa hernia. The incarcerated small intestine was released with no bowel resection. The 4-cm hernia phylum was observed and closed by simple suture. The patient had a good postoperative course without recurrence.

Conclusions: We encountered a very rare case of internal hernia in the left pararectal fossa. Preoperative diagnosis of this disease is difficult, but it should nevertheless be considered in cases in which the cause of the intestinal obstruction is unknown.

Keywords: Internal hernia; Intestinal obstruction; Pararectal fossa hernia; Perirectal fossa hernia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Computed tomography before treatment. a Abdominal computed tomography shows extensive small intestinal dilation and beak-like changes in the small intestine (arrow) on the left side of the pelvis. b A closed loop with reduced contrast effect is formed on the left side of the rectum (arrow head), and localized ascites is observed
Fig. 2
Fig. 2
Intraoperative images. a The small intestine was stuck in the pararectal fossa on the left side of the rectum (asterisk). V = ventral side. b A 4-cm hernia orifice was found in the peritoneal reflection on the left side of the rectum (asterisk)
See this image and copyright information in PMC

References

    1. Steinke CR. Internal hernia: three additional case reports. Arch Surg. 1932;25(5):909–925. doi: 10.1001/archsurg.1932.01160230092008. - DOI
    1. Newsom BD, Kukora JS. Congenital and acquired internal hernias: unusual causes of small bowel obstruction. Am J Surg. 1986;152(3):279–285. doi: 10.1016/0002-9610(86)90258-8. - DOI - PubMed
    1. Takeyama N, Gokan T, Ohgiya Y, Satoh S, Hashizume T, Hataya K, et al. CT of internal hernias. Radiographics. 2005;25(4):997–1015. doi: 10.1148/rg.254045035. - DOI - PubMed
    1. Suwa K, Yamagata T, Hanyu K, Suzuki T, Okamoto T, Yanaga K. Internal hernia through a peritoneal defect in the pouch of Douglas: report of a case. Int J Surg Case Rep. 2013;4(1):115–117. doi: 10.1016/j.ijscr.2012.10.015. - DOI - PMC - PubMed
    1. Haku T, Daidouji K, Kawamura H, Matsuzaki M. Internal herniation through a defect of the broad ligament of the uterus. Abdom Imaging. 2004;29(2):161–163. doi: 10.1007/s00261-003-0065-y. - DOI - PubMed

LinkOut - more resources