J Korean Surg Soc.  2012 Sep;83(3):179-182. 10.4174/jkss.2012.83.3.179.

Incarcerated internal hernia within a huge irreducible parastomal hernia with intestinal obstruction: a rare case report of "hernia within hernia"

• Lou JY
• Wu YL
• Wu D

• KMID: 2212292
• DOI: http://doi.org/10.4174/jkss.2012.83.3.179

Abstract

We report an incarcerated internal hernia in a huge irreducible parastomal hernia-"hernia within hernia." A 70-year-old obese woman with diabetes who underwent an abdomino-perineal resection 20 years ago was admitted to our hospital with 20 years history of a huge irreducible bulge, 25 cm in diameter. An internal hernia due to an adhesive band extending from the sac wall to proximal colon was found in the parastomal hernia sac during an emergency laparotomy. We cut off the distal colon and relocated the colostomy stoma. The patient was discharged uneventfully 2 weeks after the surgery and was readmitted to have a further laparoscopic hernia repair 8 months later. Unfortunately, an unrecognized enterotomy occurred during the secondary surgery that led to an additional laparotomy during which the mesh was not contaminated by the bowel contents and was kept in place. At 22-month follow-up, there were no evidences of recurrence.

Keyword

Ventral hernia; Incarceration; Intestinal obstruction; Herniorrhaphy

MeSH Terms

Adhesives
Aged
Colon
Colostomy
Emergencies
Female
Follow-Up Studies
Hernia
Hernia, Ventral
Herniorrhaphy
Humans
Hypogonadism
Intestinal Obstruction
Laparotomy
Mitochondrial Diseases
Ophthalmoplegia
Recurrence
Adhesives
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

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  Fig. 1 A huge irreducible bulge occupying the patient's left abdomen.

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  Fig. 2 Computed tomography scanning showed an abdominal wall defect with 10 cm in diameter and a huge mass with 25 cm in diameter containing loops of bowel.

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  Fig. 3 An adhesive band extending from the parastomal hernia sac wall to distal colon was found in the primary parastomal hernia. Some proximal colon and loops of small intestine (not included in this sketch) were incarcerated into the hernia ring formed by this adhesive band.

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  Fig. 4 The colostomy stoma was relocated into the left upper quadrant of the abdominal wall.

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  Fig. 5 Laparoscopic view of the two defects of left abdominal wall. One defect with about 12 × 10 cm in diameter located at the original stoma site while another defect with about 5 × 5 cm in diameter located at the new site of colostomy.

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