title: Early intervention in intersigmoid hernia may prevent bowel resection-A case report.
abstract: BACKGROUND
  Intersigmoid hernia is a rare internal hernia presenting with symptoms of bowel obstruction. Preoperative diagnosis is uncommon but computerised tomography (CT) may show signs to suggest internal hernia.
  
  
  METHODS
  A 63-year-old female presented with abdominal pain, vomiting and absolute constipation. Examination revealed a tense distended abdomen. A plain abdominal radiograph showed features of small bowel obstruction. Conservative management was initiated without success and a CT scan was performed which showed a dilated distal oesophagus, stomach and small bowel with a non-dilated length of distal ileum and large bowel. Internal hernia was suggested as a possible cause and the patient underwent a laparotomy where a loop of small bowel was found to be strangulated and gangrenous within the intersigmoid fossa. The gangrenous bowel was resected, an end-to-end anastamosis was performed and the fossa was closed. The patient made an uneventful recovery.
  
  
  CONCLUSIONS
  Hernias of the sigmoid mesocolon account for 6% of internal hernias with internal hernias themselves causing between 0.2 and 4.1% of intestinal obstruction. This report presents a case of intersigmoid hernia, a rare internal hernia which should be suspected in patients presenting with acute obstruction, no past surgical history and no external hernia. Patients with these symptoms should receive an urgent CT scan to facilitate early surgery and minimise strangulation and prevent bowel resection.
  
  
  CONCLUSIONS
  Intersigmoid hernia presents with acute obstruction, no past surgical history and no external hernia. Urgent CT scanning and early surgery may minimise strangulation, conserve bowel and reduce patient morbidity and mortality.
authors.affiliation: Department of Surgery, Yeovil District Hospital, Yeovil, Somerset, UK BA21 4AT.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Harrison
authors.forename: Rishabha D
authors.initials: RD
authors.lastname: Sharma
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Niayesh
references.citation: Radiology. 2002 Jun;223(3):625-32
references.pmid: 12034927
references.citation: Radiology. 2001 Jan;218(1):68-74
references.pmid: 11152781
references.citation: Ann Surg. 1964 Mar;159:382-4
references.pmid: 14129383
references.citation: Radiology. 2001 Feb;218(2):384-8
references.pmid: 11161150
references.citation: AJR Am J Roentgenol. 2006 Mar;186(3):703-17
references.pmid: 16498098
references.citation: Radiographics. 2005 Jul-Aug;25(4):997-1015
references.pmid: 16009820