Small bowel herniation through the epiploic foramen reduced laparoscopically

Area of Science:

• Gastroenterology
• Surgical Case Reports
• Abdominal Imaging

Background:

• Internal hernias, particularly through the epiploic foramen, are uncommon causes of bowel obstruction.
• Delayed diagnosis of epiploic foramen hernias is frequent due to nonspecific clinical presentations.
• These delays can lead to increased patient morbidity and mortality.

Purpose of the Study:

• To report a case of successful laparoscopic management of terminal ileum herniation through the epiploic foramen.
• To highlight the diagnostic challenges and emphasize the importance of early surgical intervention.

Main Methods:

• A 60-year-old male presented with abdominal pain and complete constipation.
• Computed tomography (CT) scan revealed small bowel dilatation with inconclusive findings.
• Diagnostic laparoscopy was performed, revealing herniation of the terminal ileum through the epiploic foramen.

Main Results:

• Laparoscopic reduction of the herniated terminal ileum was successfully achieved.
• No bowel resection was necessary, and the patient experienced an uneventful postoperative recovery.
• No recurrence of the hernia was observed during follow-up.

Conclusions:

• Herniation through the epiploic foramen requires high clinical suspicion despite rare occurrence and non-specific symptoms.
• Early diagnostic laparoscopy is vital for prompt identification and management.
• Surgical closure of the foramen is debated due to associated risks; conservative management post-reduction may be considered.