Elizabeth Guelmo-Daisley*, Ariadne Saunders, Richard Spence and Professor Shamir Cawich

Department of Surgery, Port- Of Spain General Hospital, Port- Of- Spain, Trinidad

*Corresponding Author: Elizabeth Guelmo-Daisley, Department of Surgery, Port- Of Spain General Hospital, Port- Of- Spain, Trinidad.

Received: February 22, 2022; Published: April 13, 2022

Abstract

Background: Internal hernias are an uncommon cause of small bowel obstruction. These are caused by the protrusion of viscera through defects in the mesentery or peritoneum. Pouch of Douglas hernias are an exceedingly rare type of internal hernia. As such, there are no standard guidelines for management.

Case Presentation: An elderly female presented with small bowel obstruction in the virgin abdomen, was found to have a recto uterine cul-de-sac or pouch of Douglas hernia via a computer tomography (CT) scan. Open reduction of the hernia followed by herniotomy was the method used to treat this patient.

Conclusion: Pouch of Douglas hernias are a rare type of internal hernia. It may be due to a congenital defect in the peritoneum or due to an acquired defect usually secondary to previous pelvic procedures. It may be identified via computer tomography (CT) and the definitive management is surgical due to the high risk of strangulation. Herniotomy or widening of the hernia defect, which decreases the risk of incarceration and strangulation, appears to be a valid method of definitive management of hernias within the Pouch of Douglas

Keywords: Computer Tomography; Douglas; Hernia

References

1. NELA Project Team. “Sixth patient report of the National Emergency Laparotomy Audit”. London: RCoa, (2020).
2. Amara Y., et al. “Diagnosis and management of small bowel obstruction in virgin abdomen: A WSES position paper”. World Journal of Emergency Surgery1 (2021): 36.
3. Muthukumar V., et al. “Report of a case and review of literature of internal hernia through peritoneal defect in the pouch of Douglas: A rare occurrence”. International Journal of Applied Basic Medical Research3 (2017): 196-198.
4. Subasinghe D., et al. “Jejunal obstruction due to a variant of transmesocolic hernia: a rare presentation of acute abdomen”. BMC Surgery 15 (2015): 57.
5. Doishita S., et al. “Internal hernias in the era of multidetector CT: Correlation of imaging and surgical findings”. Radiographics 1 (2016): 88-106.
6. Bunni J., et al. “Pouch of Douglas pelvic hernia: A rare entity managed laparoscopically”. Hernia 5 (2012): 601-603.
7. Fiigaard B and Agerloft A. “Internal Richter’s hernia due to congenital peritoneal defect. Case report”. Acta Chirurgica Scandanavica 9 (1988): 537.
8. Hoeffel JC., et al. “Demonstration by computed tomography of a case of internal small bowel herniation”. The British Journal of Radiology779 (1992): 1045-1046.
9. Inoue Y., et al. “CT of internal hernia through a peritoneal defect of the pouch of Douglas”. AJR American Journal of Roentgenology5 (2002): 1305-1306.
10. Suwa K., et al. “Internal hernia through a peritoneal defect in the pouch of Douglas: Report of a case”. International Journal of Case Reports1 (2013): 115-117.
11. Apturkar DK., et al. “A rare case of internal hernia through a rent in the pouch of Douglas, six years after abdominal hysterectomy”. International Journal of Biomedical Advanced Research 4 (2013): 258-260.
12. Choi PW. “Small bowel obstruction caused by internal hernia through a peritoneal defect of the pouch of Douglas: Report of a case and review of the literature”. Case Report Surgery (2017).
13. Hari GSC., et al. “Pouch of Douglas internal hernia successfully treated laparoscopically”. Journal of Minimal Access Surgery3 (2020): 71-272.

Citation

Citation: Elizabeth Guelmo-Daisley. “Small Bowel Obstruction Secondary to an Internal Hernia Through the Pouch of Douglas: A Case Report and Review of the Literature”.Acta Scientific Medical Sciences 6.5 (2022): 14-17.

Copyright

Copyright: © 2022 Elizabeth Guelmo-Daisley. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.