Morning Report

Morning Report: Mesenteric Ischemia

Presenter: Dalton Tran PGY-1

Case: 60 y.o. female presenting to the ED for sudden onset, severe abdominal pain that woke her up from sleep. The pain is constant, located mostly in the epigastric region with radiation toward the back. Findings suggestive of bowel infarction, likely due to mesenteric ischemia caused by internal hernia.

Learning Points:

  • Congenital hernias are due to abnormal fixation of mesentery. Paraduodenal hernias are due to abnormal fixation of mesentery of descending/ascending colon.
  • Internal hernias related to RYGB procedures are increasing due to increasing number of procedures.
  • 5% of bowel obstructions are caused by internal hernias.
  • UGI contrast radiography, barium radiography, CT with contrast for diagnosis.
  • Treatment is with surgical repair, laparoscopic vs open. Laparoscopic is reserved if patient presents without complication, otherwise open repair with exploration to fix the defect is preferred.

Source: 
Salar O, El-Sharkawy AM, Singh R, Speake W. Internal hernias: a brief review. Hernia (2013) 17:373-377.

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