Obstruction of the Bowel on an Inter-sigmoid Hernia: A Rare Cause of Occlusion

TL;DR

This paper presents a rare case of bowel obstruction caused by an inter-sigmoid hernia, highlighting the difficulty in diagnosing this condition before surgery.

Contribution

The paper contributes a detailed clinical case report of inter-sigmoid hernia, emphasizing its diagnostic challenges and management.

Findings

Inter-sigmoid hernia is rare and often misdiagnosed due to nonspecific symptoms.

Emergency laparotomy confirmed the diagnosis in a 63-year-old patient with intestinal occlusion.

Preoperative CT imaging failed to clearly identify the hernia, leading to delayed diagnosis.

Abstract

Inter-sigmoid hernia is a rare condition characterized by the protrusion of the small intestine into the inter-sigmoid fossa. The inter-sigmoid fossa, also known as the inter-sigmoid recess, is a funnel-shaped peritoneal pouch of variable size, located between the two mesenteric roots of the parietal margin of the meso-sigmoid.

The diagnosis of inter-sigmoid hernia is often delayed due to nonspecific clinical symptoms, which frequently leads to a postponement of surgical intervention. Preoperative detection on CT imaging can be challenging, and the diagnosis is typically confirmed during urgent surgical exploration.

We report the case of a 63-year-old man who presented to the emergency room with abdominal pain. The physical examination and radiological findings were suggestive of an intestinal occlusion over an internal hernia. Given these findings, an emergency laparotomy was performed, confirming the diagnosis of an inter-sigmoid internal hernia with incarceration of a distended segment of the small intestine.

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