Internal hernia: complex diagnostic and therapeutic problem

Internal hernias are neglected, life threatening and generally mismanaged surgical pathologies. They may be either acquired or congenital. The mortality and morbidity rates differ between the types and unfortunately reports investigating them are very rare, with limited number of patients, and mostly case reports. In this one of the largest series of the literature, we aimed to evaluate the resemblances and the differences between these two types.

From January 2001 to April 2008, 25 patients who underwent surgery for an internal hernia were evaluated. Patients were divided into two groups; group I consisted of patients with acquired internal hernia, and group II with congenital internal hernia. The patients' records, imaging modalities, and operative findings were recorded and analyzed statistically.

Group I consisted of 16 patients whilst group II consisted of nine patients. There were no significant differences between the groups with regard to gender, patients' complaints, clinical and laboratory findings, imaging modalities, types of surgical procedures, and laparotomy time. Group I was significantly older, had significantly longer length of hospital stay (13.6+/-2.3 days versus 7.2+/-1.4 days) and had significantly higher postoperative mortality rate (43.8% in group I and 22.2% in group II, p<0.01).

Acquired IH is becoming the most prevalent type of IH. They usually have rapid progression to bowel ischemia, so they have bad outcome. High index of suspicion is mandatory since the main factors that may influence the prognosis of affected patients are early diagnosis and therapy.