Internal Hernia: Types, Causes, Symptoms, Diagnosis, and Treatment

By | 01/08/2018
internal hernia icd 10

It refers to a congenital condition that consists of an intra-abdominal hernia.

Internal Hernias are protrusions of viscera through the peritoneum (a serous membrane that covers the walls of the abdominal cavity and surrounds every organ in that area) towards another section of the abdominal cavity.

Such a hernia can also occur through the mesentery (a double-layer of tissues that encloses the intestines and attaches them to the posterior abdominal wall).

Even is such cases, the protrusion still leads the viscera to another compartment of the abdominal cavity.

These protrusions are related to pre-existing anatomical structures, but in some cases, they might be the result of other different factors.

This type of hernias has a remarkably low rate of incidence; it usually represents less than 1% of all cases of hernias.

Types of Internal Hernias

After decades of research, medical experts divide Internal Hernias into several sub-types. They include the following:

Lesser Sac Hernias, a rare condition in which the abdominal content protrudes through the Epiploic Foramen, also known as Foramen of Winslow. Some call it the “Foramen of Winslow Hernia.”

Paraduodenal Hernias, a congenital anomaly that arises from an error of rotation of the midgut, which experts divide into two other sub-types:

  • Left Paraduodenal Hernias develop through the fossa of Landzert, extending into the descending mesocolon and left portion of the transverse mesocolon.
  • Right Paraduodenal Hernias develop through the fossa of Waldeyer, a congenital anomaly that connects the ascending colon mesentery to the right lower section of the peritoneum.

Pericaecal Hernias, a rare type of hernias that features intense lower abdominal pain.

Sigmoid Mesocolon Hernias, which occur due to the formation of a protrusion between two adjacent sigmoid segments (pelvic colon) and the mesentery.

Trans-omental Hernias refer to the less common type of hernias, which features a loop of the small bowel protruding through an anomaly in the Omentum (folds the peritoneum surrounding internal organs).

Supra-vesical Hernias are another unusual type of internal hernias; they develop at the fossa between the remnants of the canal that connects the urinary bladder to the umbilicus, and the left or right umbilical artery.

Pelvic Internal Hernias are a heterogeneous group of internal hernias that usually occur in the pelvis.

Falciform Ligament Hernias refer to protrusions of a loop of small bowel through a hole in the peritoneal ligament that attaches the liver to the abdominal wall.

Causes

At first, some people believed this type of hernias being acquired conditions. The result of the silent work of a bowel loop that gradually enlarges a small peritoneal fold.

This process would eventually form a protruding sac of tissues in the abdominal cavity.

However, several researchers reject such theory due to the lack of intra-peritoneal pressure needed to produce a hernia there, among other reasons.

Many medical experts support the idea of the Internal Hernia being the result of intestinal malrotation, which is a congenital anomaly that occurs when a baby’s intestines don’t form into a coil in the abdomen.

That causes the colon to get enclosed by an abnormal fold of the peritoneum.

Some other researchers believe that the colon gets trapped behind the mesentery while the rotation of the cecum occurs.

The cecum is the blind intraperitoneal pouch that connects the small intestine to the colon.

Medical experts state that the protrusion through the mesentery is the result of the rotation of the cecum from right to left until fixing the ascending colon to the posterior abdominal wall.

Other potential causes of Internal Hernias are related to physical trauma or an injury that came as a result of a surgical procedure.

Symptoms of the Internal Hernias

More often than not, the patients with this condition show no sign of having this hernia until an intestinal obstruction occurs.

Along with this intestinal obstruction, the patient may present symptoms such as abdominal pain, bilious vomit (which comes in the form of yellow-greenish fluids), and dizziness (in some cases).

Some patients could even display hypersensitivity in the area affected by the protrusion.

However, the symptoms of an Internal Hernia may vary given the position of the patient.

Diagnosis

Due to the location of this type of hernias and its intermittent nature, many doctors and surgeons find it difficult to identify this condition.

The clinical diagnosis consists of ruling out the presence of other diseases causing the symptoms.

After medical experts rule out possibilities such as gastroesophageal reflux, gastritis, gallbladder disease, and inflammatory bowel disease, they start suspecting of the presence of an Internal Hernia.

The effectivity of radiological exams will depend on the moment in which the tests get carried out.

Given the intermittent nature of this condition, some studies may show no anomaly. But, the moment the herniation becomes acute, tomographies would possibly display the location of the issue.

Internal Hernia Treatment

The best way to deal with Internal Hernias is through a surgical procedure known as Laparotomy, which consists of an incision through the abdominal wall.

The moment and the manner in which doctors may proceed will depend on the anatomical changes in the patients’ body.

Medical experts recommend intense body hydration to prepare the patients for the treatment. That will reduce some potential risks during the surgery.

Doctors must perform a careful examination of the abdominal cavity to identify the structures involved in this health issue.

During the surgery, medical experts reduce the herniated section of the intestine to get it out of the protrusion and then close the hole of this hernia.