Hernia transmesentérica. Revisión del tema a raíz de un caso exótico de infarto intestinal en un adulto

Rodolfo  Cabrales-Vega

doi:10.17533/udea.iatreia.v28n4a06

Autores/as

Rodolfo Cabrales-Vega Universidad Tecnológica de Pereira

DOI:

https://doi.org/10.17533/udea.iatreia.v28n4a06

Palabras clave:

defecto mesentérico, hernia interna, hernia transmesentérica, obstrucción intestinal

Resumen

Introducción: la hernia transmesentérica (HT) es una causa extremadamente rara de isquemia intestinal en adultos, con pocos casos reportados en la literatura.

Presentación del caso: un hombre de 71 años presentó dolor epigástrico severo de seis horas de evolución, sin signos de obstrucción intestinal ni historia de cirugías abdominales previas. Ante el deterioro clínico se hizo una laparotomía que reveló un defecto transmesentérico de 4 cm en el yeyuno y herniación de ciento noventa cm de intestino delgado con signos de gangrena. Se efectuaron reducción del contenido, resección intestinal y anatomosis primaria. La recuperación fue exitosa y fue dado de alta diez días después del ingreso.

Discusión: los síntomas clínicos, los estudios radiológicos y los datos de laboratorio suelen ser inespecíficos para el diagnóstico de HT. La tasa de mortalidad puede superar el 50 %. Este artículo resume las características clínicas más importantes a partir de una revisión exhaustiva de la literatura.

Conclusión: la obstrucción intestinal por HT es una condición potencialmente letal. Los signos y síntomas clínicos relacionados con HT exigen un estricto seguimiento. Si no hay mejoría o se presenta deterioro clínico, se debe hacer una cirugía temprana con el fin de reducir la mortalidad y la morbilidad por esta causa.

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Biografía del autor/a

Rodolfo Cabrales-Vega, Universidad Tecnológica de Pereira

Médico General, Universidad Tecnológica de Pereira. Especialista en Cirugía General, Universidad de Caldas. Doctor en Ciencias de la Educación, Red de Universidades Estatales de Colombia (RUDECOLOMBIA). Profesor Titular, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Colombia.

Citas

(1.) Gyedu A, Damah M, Baidoo PK, Yorke J. Congenital transmesenteric defect causing bowel strangulation in an adult. Hernia. 2010 Dec;14(6):643-5.

(2.) Fan HP, Yang AD, Chang YJ, Juan CW, Wu HP. Clinical spectrum of internal hernia: a surgical emergency. Surg Today. 2008;38(10):899-904.

(3.) Crispín-Trebejo B, Robles-Cuadros MC, Orendo-Velásquez E, Andrade FP. Internal abdominal hernia: Intestinal obstruction due to transmesenteric hernia containing transverse colon. Int J Surg Case Rep [Internet] 2014. [cited 2014 Dic 14];5(7):[396-8]. Available from: http://www.sciencedirect.com/science/article/pii/S2210261214000182

(4.) Aghajani E, Jacobsen HJ, Nergaard BJ, Hedenbro JL, Leifson BG, Gislason H. Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg. 2012 Mar;16(3):641-5.

(5.) Daskalaki A, Kaimasidis G, Xenaki S, Athanasakis E, Chalkiadakis G. Internal-mesocolic hernia after laparoscopic left colectomy report of case with late manifestation. Int J Surg Case Rep. 2015;6C:88-91.

(6.) Dritsas ER, Ruiz OR, Kennedy GM, Blackford J, Hasl D. Paraduodenal hernia: a report of two cases. Am Surg. 2001 Aug;67(8):733-6.

(7.) Nouira F, Dhaou BM, Charieg A, Ghorbel S, Jlidi S, Chaouachi B. Small bowel obstruction caused by congenital transmesenteric defect. Afr J Paediatr Surg. 2011 Jan-Apr;8(1):75-8.

(8.) Malit M, Burjonrappa S. Congenital mesenteric defect: Description of a rare cause of distal intestinal obstruction in a neonate. Int J Surg Case Rep [Internet] 2012. [cited 2014 Dic 15]; 3(3):[121-3]. Available from: http://www.sciencedirect.com/science/article/pii/S2210261211001477

(9.) Butterworth J, Cross T, Butterworth W, Mousa P, Thomas S. Transmesenteric hernia: A rare cause of bowel ischaemia in adults. Int J Surg Case Rep [Internet] 2013. [cited 2014 Dic 12];4(7):[568-70]. Available from: http://www.sciencedirect.com/science/article/pii/S2210261213001089

(10.) Katagiri H, Okumura K, Machi J. Internal hernia due to mesenteric defect. J Surg Case Rep. 2013 May;2013(5):1-3.

(11.) Puri V, Bertellotti RP, Garg N, Fitzgibbons RJ Jr. Intramesosigmoid hernia: a rare type of congenital inter-nal hernia. Hernia. 2007 Oct;11(5):463-5.

(12.) Zerrweck C, Sánchez HA, Posada JA, Cervantes J. Giant congenital mesenteric hernia in the adult. Acta Chir Belg. 2009 Oct;109(5):620-2.

(13.) Abu-Jaish W, Forgione P. Internal Hernias: Congenital and Acquired. In: Yeo CJ, McFadden DW, Pemberton JH, Peters JH, Matthews JB. Shackelford’s Surgery of the Alimentary Tract. 7ª ed. Philadelphia: Elsevier Health Sciences; 2012. p. 953-60.

(14.) Chaudhary P, Rao M, Kumar A, Khandelwal S, Gupta N, Arora MP. Spontaneous transmesenteric hernia: a rare cause of small bowel obstruction in an adult. Clin Pract. 2013 Feb;3(1):e6.

(15.) Capito C, Podevin J, Lascarrou JB, Lehur PA, Armstrong O. Large congenital transmesenteric her-nia: a missed small-bowel atresia? Hernia. 2009 Apr;13(2):209-11.

(16.) Cutler GD, Scott HW. Transmesenteric hernia. Surg Gynecol Obstet. 1944;79:509-15.

(17.) Mueller EC. Congenital internal hernia. Am J Surg. 1959 Feb;97(2):201-4.

(18.) Takeda M, Ohnuki Y, Uchiyama T, Kubota O, Ohis-hi K. Small intestinal strangulation due to a rare type of primary internal hernia. Int Surg. 2013 Oct-Dec;98(4):409-11.

(19.) Kandpal H, Sharma R, Saluja S, Sahni P, Vashisht S. Combined transmesocolic and left paraduodenal hernia: barium, CT and MRI features. Abdom Imaging. 2007 Mar-Apr;32(2):224-7.

(20.) Kundaragi NG, Vinayagam S, Mudali S. Stretched bowel sign in combined transmesocolic and transomental internal hernia: A case report and review of literature. Indian J Radiol Imaging. 2014 Apr;24(2):171-4.

(21.) Narjis Y, Jgounni R, El Mansouri MN, Rabbani K, Hiroual R, Belhadj K, et al. Transmesocolic internal herniation: a rare case of small bowel obstruction, “the Marrakesh hernia”. Hernia. 2010 Aug;14(4):427-9.

(22.) Suwa K, Yamagata T, Hanyu K, Suzuki T, Okamoto T, Yanaga K. Internal hernia through a peritoneal defect in the pouch of Douglas: Report of a case. Int J Surg Case Rep [Internet] 2013. [cited 2014 Dic 12]; 4(1):[115-7]. Available from: http://www.sciencedirect.com/science/article/pii/S2210261212001988

(23.) Jung P, Kim MD, Ryu TH, Choi SH, Kim HS, Lee KH, et al. Transmesocolic hernia with strangulation in a patient without surgical history: case report. World J Gastroenterol. 2013 Mar;19(12):1997-9.

(24.) Benson JR, Killen DA. Internal hernias involving the sigmoid mesocolon. Ann Surg. 1964 Mar;159:382-4.

(25.) Ghahremani GG. Internal abdominal hernias. Surg Clin North Am. 1984 Apr;64(2):393-406.

(26.) Meyers MA, Charnsangavej C, Oliphant M. Internal Abdominal Hernias. In: Dynamic radiology of the abdomen: normal and pathologic anatomy. 5ª ed. New York: Springer; 2006. p. 381-407.

(27.) Edwards HM, Al-Tayar H. A transmesenteric congenital internal hernia presenting in an adult. J Surg Case Rep. 2013 Dec;2013(12).

(28.) Chaudhary B, Anand U, Priyadarshi RN. Left paraduodenal hernia. J Anat Soc India. 2014 Dec;63(3):S39-41.

(29.) Chatterjee S, Chatterjee S, Kumar S, Gupta S. Acute intestinal obstruction: a rare aetiology. Case Rep Surg [Internet] 2012. [cited 2014 Dic 13]; 2012:[501209]. Available from: http://www.hindawi.com/journals/cris/2012/501209/

(30.) Mozaffar M, Hasani M, Fallah M, Sobhiyeh MR, Ad-hami F. A left paraduodenal hernia causing bowel obstruction: a case report. Gastroenterol Hepatol Bed Bench. 2013 Winter;6(1):48-51.

(31.) Al-Khyatt W, Aggarwal S, Birchall J, Rowlands TE. Acute intestinal obstruction secondary to left paraduodenal hernia: a case report and literature review. World J Emerg Surg [Internet] 2013 Jan. [cited 2014 Dic 13]; 8(1):[5]. Available from: http://www.biomedcentral.com/content/pdf/1749-7922-8-5.pdf

(32.) Vieira L, James S. An internal hernia causes abdominal pain and small bowel obstruction. JAAPA. 2012 Jan;25(1):37, 43-4.

(33.) Gomes R, Rodrigues J. Spontaneous adult transmesentric hernia with bowel gangrene. Hernia. 2011 Jun;15(3):343-5.

(34.) Salar O, El-Sharkawy AM, Singh R, Speake W. Internal hernias: a brief review. Hernia. 2013 Jun;17(3):373-7.

(35.) Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006 Mar;186(3):703-17.

(36.) Takeda M, Ohnuki Y, Uchiyama T, Kubota O, Ohishi K. Small intestinal strangulation due to a rare type of primary internal hernia. Int Surg. 2013 Oct-Dec;98(4):409-11.

(37.) Hashimoto D, Hirota M, Sakata K, Yagi Y, Baba H. Adult transmesenteric hernia: report of two cases. Surg Today. 2012 May;42(5):489-92.

(38.) Jain SK, Kaza RC, Garg PK. Incidental congenital transmesenteric hernia in an adult. Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):461-2.

(39.) Darii E, Cazacov V, Eachempati SR, Todd SR. A true congenital internal hernia identified after a motor vehicle collision. Am Surg. 2012 Feb;78(2):264-6.

(40.) Vallumsetla R, Govind Rao N. Congenital transmesenteric internal hernia – A case report with literature review. Indian J Surg. 2010 Jun;72(3):268-70.

(41.) Ghiassi S, Nguyen SQ, Divino CM, Byrn JC, Schlager A. Internal hernias: clinical findings, management, and outcomes in 49 nonbariatric cases. J Gastrointest Surg. 2007 Mar;11(3):291-5.

(42.) Blachar A, Federle MP. Internal hernia: an increasingly common cause of small bowel obstruction. Semin Ultrasound CT MR. 2002 Apr;23(2):174-83.

(43.) Camera L, De Gennaro A, Longobardi M, Masone S, Calabrese E, Del Vecchio W, et al. A spontaneous strangulated transomental hernia: Prospective and retrospective multidetector computed tomography findings. World J Radiol. 2014 Feb;6(2):26-30.

(44.) Zissin R, Hertz M, Gayer G, Paran H, Osadchy A. Congenital internal hernia as a cause of small bowel obstruction: CT findings in 11 adult patients. Br J Radiol. 2005 Sep;78(933):796-802.

(45.) Blachar A, Federle MP, Brancatelli G, Peterson MS, Oliver JH 3rd, Li W. Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology. 2001 Nov;221(2):422-8.

(46.) Iannuccilli JD, Grand D, Murphy BL, Evangelista P, Roye GD, Mayo-Smith W. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Clin Radiol. 2009 Apr;64(4):373-80.

(47.) Cohen AM, Patel S. Arteriographic findings in congenital transmesenteric internal hernia. AJR Am J Roentgenol. 1979 Sep;133(3):541-3.

(48.) ur Rehman Z, Khan S. Large congenital mesenteric defect presenting in an adult. Saudi J Gastroenterol. 2010 Jul-Sep;16(3):223-5.

(49.) Hussein M, Khreiss M, Al-Helou G, Alaeddine M, Elias E, Abi Saad GS. Laparoscopic repair of a left paraduodenal hernia presenting with acute bowel obs-truction: report of a case. Surg Laparosc Endosc Percutan Tech. 2012 Feb;22(1):e28-30.

(50.) Akyildiz H, Artis T, Sozuer E, Akcan A, Kucuk C, Sensoy E, et al. Internal hernia: complex diagnostic and therapeutic problem. Int J Surg. 2009 Aug;7(4):334-7.

(51.) Lu-Chih K, Yu-Jang S, Yen-Chun L. Transmesenteric internal herniation of small bowel in an elderly. Int J Gerontol. 2012 Mar;6(1):58-9.

(52.) Alvarez-Seoane R, González-Rodríguez FJ, Paulos A, Potel Lesquereaux J. Hernia transmesentérica congénita en el anciano. Cir Esp. 2007 Nov;82(5):314-5.

(53.) Beardsley C, Furtado R, Mosse C, Gananadha S, Fergusson J, Jeans P, et al. Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. Am J Surg. 2014 Aug;208(2):243-8.