First description of an acquired internal hernia: a case report

Background An internal hernia is defined as a protrusion from intestines or other abdominal organs through a congenital or acquired aperture within the peritoneal cavity. Internal hernia are rare, with an incidence of less than 1%. Mostly, they are located paraduodenal (Treitz hernia) and show mortality rates up to 50%. Case presentation We describe the case of a 26-year-old man presenting with acute bowel obstruction and a history of surgical treatment for a congenital diaphragmatic hernia. Methods Clinical examination and computed tomography (CT) scan were interpreted as intestinal obstruction. Exploratory laparotomy resulting in an appendectomy, small intestine resection, and lysis of adhesions was performed. Results In situ, an atypical appendix fused to the spleen was detected, forming an aperture within the peritoneal cavity with protrusion and strangulation of the small intestine. The small intestine specimen sent to pathology confirmed necrotic small intestine mucosa. Conclusion We present the first description of a young man with an internal hernia due to an intraperitoneal aperture formed by his appendix fused to the spleen. Internal hernia are difficult to diagnose but should be included in the differential diagnosis in cases of intestinal obstruction. CT should be performed in cases of suspicion. Surgical intervention shouldn't be delayed in order to reduce the high morbidity and mortality rates.