Retro-Appendicular Internal Hernia: A Rare Cause of Small Bowel Obstruction

TL;DR

A rare case of retro-appendicular internal hernia causing bowel obstruction is reported in a patient with no prior abdominal surgery.

Contribution

Highlights a rare anatomical variant and emphasizes the importance of early diagnosis in atypical presentations.

Findings

Retro-appendicular internal hernia can occur without prior abdominal surgery.

CT imaging and laparoscopy confirmed the diagnosis and allowed successful treatment.

Early surgical exploration prevents complications like bowel necrosis.

Abstract

Internal hernias are rare causes of small bowel obstruction and are often difficult to diagnose preoperatively. Retro-appendicular internal hernias are exceedingly rare, with very few reports in the literature. This case is noteworthy for involving a patient with no prior history of abdominal surgery, highlighting an unusual presentation of a retro-appendicular internal hernia.

A man in his mid-60s, with no history of abdominal surgery, presented to the emergency department with acute right lower quadrant abdominal pain. Physical examination revealed localized peritonism, and laboratory results were unremarkable. CT showed signs of small bowel distension with segmental hypoperfusion of the bowel loop in the right lower quadrant. Given the clinical presentation of an acute abdomen, the patient underwent exploratory laparoscopy, which revealed a herniation of the small intestine into the retro-appendicular space. The herniated bowel appeared ischemic but was successfully reduced without further need for resection. The patient had an uneventful postoperative recovery.

This case underscores the importance of considering internal hernias in the differential diagnosis of acute abdomen, even in patients without prior abdominal surgery. Awareness of rare anatomical variants such as retro-appendicular hernias is critical, as early surgical exploration can prevent bowel necrosis and reduce morbidity. This report contributes to the limited research literature on retro-appendicular internal hernias and emphasizes the value of maintaining a high index of suspicion in atypical presentations.

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