Enteric internal hernia in postoperative period of Hartmann's sigmoidectomy

Abstract

AIMS: To report the case of a patient with acute intestinal obstruction by internal hernia, that presented a challenging diagnosis due to previous procedures and individual profile, and to perform a brief review of the literature on the types of hernia. CASE DESCRIPTION: A 44 year-old man, alcoholic, crack user, with prior surgery for reduction of prolapsed colostomy, returns to the emergency room two days after the procedure, with epigastric pain, nausea, vomiting and without bowel movement. There was progression of the disease to acute abdomen in 24 hours. An exploratory laparotomy revealed an inflammatory mass adhering to the left colon stoma and abdominal wall, with herniation of a segment of small intestine. CONCLUSIONS: Acute abdomen may be a condition of difficult clinical management in some cases, as the one herein reported, where initial clinical signs and symptoms did not portray the severity of the disease. Cases as this one may be used as examples for decision-making in difficult situations.