Unveiling the hidden ring: A case report of unique presentation of internal hernia

Abstract

Internal hernias are a rare cause of small-bowel obstruction (SBO), particularly in patients without prior abdominal surgery. This case report describes a 70-year-old male presenting with acute intestinal obstruction in a virgin abdomen. Initial imaging suggested SBO but failed to identify a clear transition point. Diagnostic laparoscopy revealed a rare internal hernia caused by a ring formed by the inflamed epiploic appendages of the sigmoid colon. The entrapped bowel was successfully released, and histopathological examination confirmed epiploic appendagitis. This case highlights the diagnostic challenges of SBO due to internal hernias and underscores the importance of surgical exploration in unclear cases. Early identification and intervention are crucial to prevent complications such as bowel ischaemia. This report contributes to the limited literature on epiploic appendage-induced internal hernias, emphasising the need for multidisciplinary collaboration in managing rare abdominal pathologies.

Keywords: Abdominal pain; epiploic appendagitis; internal hernia; laparoscopy; small-bowel obstruction.