title: Rare Hernias Presenting as Acute Abdomen- A Case Series.
abstract: Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. It can be divided into internal, external and diaphragmatic hernias. Most of them can be asymptomatic. If they become symptomatic they can present with features of intestinal obstruction, incarceration or strangulation. In this case series we compare the incidence of these rare presentations of hernias with world literature and to warn surgeons not to cut the obstructing band in cases of internal hernias. In this case series, we review the clinical details of 7 rare presentations of hernia, who presented with various types of hernias to a tertiary care centre in Kerala over a period of one year. Of these 7 cases 6 cases were internal hernias (3 left paraduodenal hernias, 2 transmesentric hernias, and 1 pericaecal hernia) and a case of spigelian hernia above the level of umbilicus. All of them presented as acute abdomen in the emergency department. Among these 7 cases, only one case was diagnosed preoperatively. Three patients had bowel gangrene and had to undergo resection- anastomosis of the bowel. The survival rate among these cases was 100% as compared to 50% in the world literature if they had been left untreated. Even though internal hernias are a rare entity, we need to have it as a differential diagnosis in case of intestinal obstruction, in a previously non-operated abdomen.
authors.affiliation: Senior Resident, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: Roney Johnson
authors.initials: RJ
authors.lastname: John
authors.affiliation: Assistant Professor, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: Sansho Elavumkal
authors.initials: SE
authors.lastname: Ulahannan
authors.affiliation: Professor and Head of the Department, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: John S
authors.initials: JS
authors.lastname: Kurien
authors.affiliation: Senior Resident, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: Aneesh
authors.initials: A
authors.lastname: Joseph
authors.affiliation: Senior Resident, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: Annie Sandhya
authors.initials: AS
authors.lastname: Kurien
authors.affiliation: Assistant Professor, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: Sandeep Abraham
authors.initials: SA
authors.lastname: Varghese
authors.affiliation: Junior Resident, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: Bindhya
authors.initials: B
authors.lastname: Thomas
authors.affiliation: Junior Resident, Department of General Surgery, Government Medical College , Kottayam, Kerala, India .
authors.forename: Fobin
authors.initials: F
authors.lastname: Varghese
keywords: Abdominal wall abscess; Internal hernia; Intestinal obstruction; Spigelian hernia