A. Incidence of Internal Hernias
B. Etiology of Internal Hernias
C. Diagnosis of Internal Hernias
- Clinical presentation. These hernias usually are diagnosed because an intestinal segment becomes incarcerated within the internal defect, resulting in small-bowel obstruction. Patients with congenital causes usually have not had prior abdominal surgery. The reported mortality in acute intestinal obstruction secondary to internal hernias is 10% to 16%. Symptoms usually are of intestinal obstruction without evidence of an external hernia. When there is intestinal obstruction or intestinal strangulation, the diagnosis is based on clinical rather than on laboratory findings.
- Radiographic studies. Plain abdominal films may show small-bowel obstruction. An abdominal CT scan can sometimes establish the diagnosis of an internal hernia preoperatively. Contrast studies may also sometimes be useful.
D. Differential diagnosis
E. Surgical treatment of internal hernia
of Internal Hernias
s often made at laparotomy for small-bowel obstruction. Intestinal loops proximal to the obstruction are dilated, friable, and edematous above the obstruction and collapsed distal to it. Once the hernia is reduced, intestinal viability is assessed, and nonviable intestine is removed. If a large percentage of bowel is of questionable viability, a limited bowel resection followed by a second-look laparotomy in 24 to 48 hours may preserve small-bowel length. The hernia defect should be closed primarily with nonabsorbable suture.
Dr Adarsh M Patil mbbs ms
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