TY - JOUR
T1 - Pre-operative diagnosis and successful surgery of a strangulated internal hernia through a defect in the falciform ligament
T2 - A case report
AU - Shiozaki, Hironori
AU - Sakurai, Shintaro
AU - Sudo, Kazuki
AU - Shimada, Gen
AU - Inoue, Hiroshi
AU - Ohigashi, Seiji
AU - Deshpande, Gautam A.
AU - Takahashi, Osamu
AU - Onodera, Hisashi
PY - 2012
Y1 - 2012
N2 - Introduction: Internal hernia within the falciform ligament is exceedingly rare. A literature search revealed only 14 cases of internal herniation of the small bowel through a congenital defect of the falciform ligament, most of which were found intra-operatively. Case presentation: A 77-year-old Japanese woman presented to our emergency department with sudden hematemesis, occurring at least four to five times over a 12-hour period. No ulcer or gastrointestinal bleeding was detected on gastroendoscopy. A 40mm mass in the inferior lobe of the right lung was found on a chest X-ray, and our patient's symptoms were therefore initially ascribed to aspirated blood from lung tumor-associated hemoptysis. However, our patient continued to show signs of severe abdominal pain and decreased urine output despite aggressive hydration, leading her examining physicians to search for a possibly severe, occult abdominal pathology. On emergent computed tomography imaging, we found an acute strangulated internal hernia within the falciform ligament. Diagnosis was made by helical computed tomography, permitting rapid surgical intervention. Conclusions: Our findings on computed tomography imaging assisted with the pre-operative diagnosis and enabled us to make a rapid surgical intervention. Early diagnosis may help preclude significant strangulation with unnecessary resection.
AB - Introduction: Internal hernia within the falciform ligament is exceedingly rare. A literature search revealed only 14 cases of internal herniation of the small bowel through a congenital defect of the falciform ligament, most of which were found intra-operatively. Case presentation: A 77-year-old Japanese woman presented to our emergency department with sudden hematemesis, occurring at least four to five times over a 12-hour period. No ulcer or gastrointestinal bleeding was detected on gastroendoscopy. A 40mm mass in the inferior lobe of the right lung was found on a chest X-ray, and our patient's symptoms were therefore initially ascribed to aspirated blood from lung tumor-associated hemoptysis. However, our patient continued to show signs of severe abdominal pain and decreased urine output despite aggressive hydration, leading her examining physicians to search for a possibly severe, occult abdominal pathology. On emergent computed tomography imaging, we found an acute strangulated internal hernia within the falciform ligament. Diagnosis was made by helical computed tomography, permitting rapid surgical intervention. Conclusions: Our findings on computed tomography imaging assisted with the pre-operative diagnosis and enabled us to make a rapid surgical intervention. Early diagnosis may help preclude significant strangulation with unnecessary resection.
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U2 - 10.1186/1752-1947-6-206
DO - 10.1186/1752-1947-6-206
M3 - Article
C2 - 22805200
AN - SCOPUS:84864667884
SN - 1752-1947
VL - 6
JO - Journal of Medical Case Reports
JF - Journal of Medical Case Reports
M1 - 206
ER -