Internal Hernia Incarceration Mimicking Impending Rupture of an Abdominal Aortic Aneurysm

Hanae Sasaki＊	Ryosuke Kowatari＊	Norihiro Kondo＊
Tomonori Kawamura＊	Masahito Minakawa＊

（Hirosaki University Graduate School of Medicine Thoracic and Cardiovascular Surgery＊, Hirosaki, Japan）

A 68-year-old man visited a family physician with a complaint of epigastric pain lasting several hours. Computed tomography revealed an abdominal aortic aneurysm that was 60mm in length and a small amount of ascites, resulting in a tentative diagnosis of impending rupture of the abdominal aortic aneurysm. The patient was referred to our hospital and underwent emergency surgery. Intraoperative findings ruled out rupture and inflammatory changes in the abdominal aortic aneurysm. We observed the abdominal cavity and detected an internal hernia. The 15-cm-long ileum was incarcerated by an abnormal cord between the vesicorectal fossa and peritoneum. The cord was dissected to release the internal hernia. Intestinal peristalsis and pulsation of the marginal artery were maintained, allowing us to avoid intestinal resection. The patient reported that his epigastric pain disappeared soon after surgery. On the 24th postoperative day, the patient underwent abdominal aortic replacement. Our case suggests that internal hernia incarceration is an important differential diagnosis of impending rupture of an abdominal aortic aneurysm, even in cases with no history of laparotomy.

 

Jpn. J. Cardiovasc. Surg. 50:314-316（2021）

Keywords：abdominal aortic aneurysm;internal hernia