Case study: small bowel obstruction
This article describes the case of a 51-year-old diagnosed with small bowel obstruction, secondary to congenital dual internal hernias. The patient presented with complaints of colicky abdominal pain, distension, constipation and bilious vomiting with a history of 3 days. He did not smoke and had no trouble performing his daily activities.
Investigations and diagnosis
Examination showed that the patient’s vital signs were within normal range. His medical history did not reveal any significant findings of abdominal trauma, surgery or past medical conditions. In addition, palpation did not reveal any palpable masses or external hernias. There were also no signs of peritonitis present. Doctors further suggested blood tests, findings of which were within normal range. However, the abdominal X-ray showed dilated loops of the small bowel with multiple air-fluid levels. CT of the abdomen and pelvis with IV contrast was significant for small bowel clusters in the upper left quadrant. Two transition points were also identified, consistent with a closed-loop obstruction.
The patient was resuscitated and referred for surgery
Treatment included emergent laparotomy. The laparotomy confirmed the diagnosis of small bowel obstruction. The procedure also showed signs of constriction at both anatomical sites. The entrapped bowel was reduced easily and there was no small bowel ischemia. There were no other pathologies identified. The patient’s recovery period was uneventful. And on the 2nd day, his bowel function returned. Doctors discharged him on the 4th day of the procedure. The patient returned for a follow-up a year later. He was doing well and had no further symptoms.
Internal hernias often lead to protrusion of the small bowel through the mesenteric and peritoneal space in the pelvic and abdominal cavity. Congenital internal hernias, at a young age, usually present with small bowel obstruction. In older patients, the hernias are usually secondary to previous surgery. However, in this case, the patient suffered from small bowel obstruction because of internal small bowel hernias and had no history of surgery.
Source: American Journal of Case Reports
