An Unusual Case of Internal Hernia Caused by Adhesion between the Sigmoid Colon and Salpingectomy Site

摘要

Internal hernia, in which the bowel herniates through a congenital or acquired aperture in the peritoneal cavity, is one of the rarest causes of ileus. Postoperative adhesion is a common pathological phenomenon that may cause bowel obstruction by angulation or twisting. However, internal herniation through a colonic adhesion formed after gynecologic surgery is extremely rare. Here, we present a case of strangulated small bowel obstruction in a 51-year-old woman, due to internal hernia through the aperture created by adhesion of the sigmoid colon and a right salpingectomy site. The patient presented with abdominal pain and distension; she had a history of right salpingectomy for ectopic pregnancy 20 years earlier. While attempting conservative management, peritoneal irritation signs developed and emergency surgery was performed. During the operation, it was found that approximately 30 cm of the ileum had herniated through the aperture created by the adhesion. After reduction of the incarcerated small bowel, bowel resection with primary anastomosis and adhesiolysis was performed. Although preoperative diagnosis is difficult in unusual types of internal hernias, due to their rarity, a high degree of suspicion and prompt management is crucial for the prevention of morbidity and mortality.