BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
小肠梗阻(SBO)是临床常见的急腹症,若未能及时诊断和处理,可能引发严重并发症,甚至死亡。特别是在老年患者中,由于生理机能下降,肠坏死的发生率较高。本文回顾了小肠梗阻的诊断方法、影像学检查及治疗进展,重点讨论了CT、X线、超声和MR...小肠梗阻(SBO)是临床常见的急腹症,若未能及时诊断和处理,可能引发严重并发症,甚至死亡。特别是在老年患者中,由于生理机能下降,肠坏死的发生率较高。本文回顾了小肠梗阻的诊断方法、影像学检查及治疗进展,重点讨论了CT、X线、超声和MRI等影像学手段在诊断中的应用,特别是如何通过影像学特征预测肠缺血和坏死。此外,文章还探讨了生物标志物(如乳酸、D-二聚体、PCT和I-FABP)在肠缺血诊断中的潜力。手术治疗和保守治疗的适应症及决策依据也得到了详细分析。尽管现有诊疗方案已取得一定成效,但对于早期肠绞窄和缺血的识别仍存在挑战,未来需要更多多中心研究优化诊断和治疗策略。Small bowel obstruction (SBO) is a common acute abdominal condition, which, if not diagnosed and managed promptly, may lead to severe complications, including death. This risk is particularly higher in elderly patients due to diminished physiological function and increased likelihood of bowel necrosis. This review discusses the diagnostic methods, imaging techniques, and therapeutic advances in SBO, with a focus on the use of CT, X-ray, ultrasound, and MRI in diagnosis, particularly in predicting bowel ischemia and necrosis through imaging features. Furthermore, the potential of serum biomarkers such as lactate, D-dimer, procalcitonin (PCT), and intestinal fatty acid-binding protein (I-FABP) in diagnosing bowel ischemia is explored. The indications for and decision-making processes surrounding both surgical and conservative treatments are also analyzed. While current diagnosis and treatment strategies have shown effectiveness, early identification of bowel strangulation and ischemia remains a challenge, highlighting the need for more multicenter studies to optimize diagnosis and treatment strategies.展开更多
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
文摘小肠梗阻(SBO)是临床常见的急腹症,若未能及时诊断和处理,可能引发严重并发症,甚至死亡。特别是在老年患者中,由于生理机能下降,肠坏死的发生率较高。本文回顾了小肠梗阻的诊断方法、影像学检查及治疗进展,重点讨论了CT、X线、超声和MRI等影像学手段在诊断中的应用,特别是如何通过影像学特征预测肠缺血和坏死。此外,文章还探讨了生物标志物(如乳酸、D-二聚体、PCT和I-FABP)在肠缺血诊断中的潜力。手术治疗和保守治疗的适应症及决策依据也得到了详细分析。尽管现有诊疗方案已取得一定成效,但对于早期肠绞窄和缺血的识别仍存在挑战,未来需要更多多中心研究优化诊断和治疗策略。Small bowel obstruction (SBO) is a common acute abdominal condition, which, if not diagnosed and managed promptly, may lead to severe complications, including death. This risk is particularly higher in elderly patients due to diminished physiological function and increased likelihood of bowel necrosis. This review discusses the diagnostic methods, imaging techniques, and therapeutic advances in SBO, with a focus on the use of CT, X-ray, ultrasound, and MRI in diagnosis, particularly in predicting bowel ischemia and necrosis through imaging features. Furthermore, the potential of serum biomarkers such as lactate, D-dimer, procalcitonin (PCT), and intestinal fatty acid-binding protein (I-FABP) in diagnosing bowel ischemia is explored. The indications for and decision-making processes surrounding both surgical and conservative treatments are also analyzed. While current diagnosis and treatment strategies have shown effectiveness, early identification of bowel strangulation and ischemia remains a challenge, highlighting the need for more multicenter studies to optimize diagnosis and treatment strategies.
