Intraoperative diagnosis of rare pediatric internal hernias: A case series

Abstract

Introduction

Internal hernias are a rare but serious condition in pediatric patients. Even with a thorough preoperative imaging workup, distinguishing them from other causes of bowel obstruction is challenging. This case series presents three patients with internal hernias of varying etiologies and complexity that were not diagnosed until intraoperative exploration.

Case series

Case 1 is a previously healthy 11-year-old boy with new-onset abdominal pain and emesis who was found to have a strangulated segment of small bowel herniated through a small congenital mesenteric defect. Case 2 is a 3-year-old boy with constipation presenting with acute-on-chronic abdominal pain. He was found to have a hernia sac formed from an abnormal attachment of omentum to the retroperitoneum, which contained segments of small and large bowel. Case 3 is a 23-year-old female with ataxia-telangiectasia-like syndrome and dystonia with a gastrostomy tube who presented with emesis and reflux. Surgical exploration revealed a highly unusual internal hernia through the hepatoduodenal and transverse mesocolon, through which the entire small bowel and majority of the transverse colon were herniated. None of these internal hernias were diagnosed with preoperative imaging. All patients underwent successful internal hernia repair with resolution of abdominal symptoms and have not required additional surgical workup.

Conclusion

Frequently, the diagnosis of an internal hernia is difficult to define preoperatively and is only made at the time of surgical exploration. Although internal hernias are rare, they should remain on the differential in pediatric and young adult patients presenting with signs of acute and/or chronic bowel obstruction.