Treves’ field congenital hernias in children: an unsuspected rare cause of acute small bowel obstruction
Tóm tắt
The Treves’ field congenital hernias (TFCH) are an unusual cause of bowel obstruction that may result in irreversible damage of the small bowel or a fatal outcome, unless treated timely and properly. We analyzed retrospectively the medical records of four patients who underwent surgery for TFCHs over a period of 9 years. The types of TFCHs, only diagnosed at surgery, were identified as transmesenteric through a defect in Treves’ field in three patients, and as hernia into Treves’ field pouch in one patient. Patients had non-specific clinical manifestations, and imaging findings demonstrated only small bowel obstruction. Delay in accurate preoperative diagnosis, and especially patient-related delay, led to a primary enterectomy–anastomosis for necrotic small bowel in the patients with transmesenteric hernias. One infant with necrotic bowel died postoperatively. It may be difficult to diagnose TFCHs in children preoperatively. Misdiagnosis of bowel obstruction caused by this type of internal hernia might lead to small bowel necrosis or death. The risk of this complication seems to be more influenced by pre-hospital delay. Awareness of the severe consequences of delay in diagnosis, high clinical suspicion, early recognition, and proper surgical intervention are essential in the successful management of TFCHs.
Tài liệu tham khảo
Janin Y, Stone AM, Wise L (1980) Messenteric hernia. Surg Gynecol Obstet 150:747–754
Lough JO, Estrada RL, Wiglesworth FW (1969) Internal hernia into Treves’ field pouch. Report of two cases and review of literature. J Pediatr Surg 4:198–207
Harbin WP, Andres J, Kim SH et al (1979) Intestinal into Treves’ field pouch. Cases report and review of the literature. Radiology 130:71–72
Garay J, Benavent MI, Cuadrados J et al (1978) Internal hernia through Treves’ avascular field defect. An Esp Pediatr 11:783–788
Fujita A, Takaya J, Takada K et al (2003) Transmesenteric hernia: report of two patients with diagnostic emphasis on plain abdominal X-ray findings. Eur J Pediatr 162:147–149
Blachar A, Federle MP, Brancatelli G et al (2001) Radiologist performance in the diagnosis of internal hernia by using specific CT finding with emphasis on transmesenteric hernia. Radiology 221:422–428
Zissin R, Hertz M, Gayer G et al (2005) Congenital internal hernia as a cause of small bowel obstruction: CT findings in 11 adult patients. Br J Radiol 78:796–802
Hong SS, Kim AY, Kim PN et al (2005) Current diagnostic role of CT in evaluating internal hernia. J Comput Assist Tomogr 29:604–609
Mathieu D, Luciani A (2004) Internal abdominal herniations. AJR Am J Roentgenol 183:397–404
Treves F (1885) Lectures on the anatomy of the internal canal and peritoneum in man. Br Med J Lecture I, 1:415–419, Lecture II, 1:470–474, Lecture III, 1:580–583
Bertelsen S, Christiansen J (1967) Internal hernia through mesenteric and mesocolic defects. Review of the literature and a report of two cases. Acta Chir Scand 133:426–428
Arnheim EE, Razin E (1961) Mesenteric hernias in infancy and childhood. J Mt Sinai Hosp NY 28:543–549
Williamson JCFL (1933) Internal hernia through congenital aperture in mesentery strangulation. Br J Surg 20:684–688
Cutler GD, Scott WH Jr (1944) Transmesenteric hernia. Surg Gynecol Obstet 79:509–521
Johnson JR (1950) Internal hernia. Arch Surg 60:1171–1182
Rigler LG, Pogue WL (1965) Roentgen signs of intestinal necrosis. AJR Am J Roentgenol 94:402–409
Wachsberg RH, Helinek TG, Merton DA (1994) Internal abdominal hernia: diagnosis with ultrasonography. Can Assoc Radiol J 45:223–224
Blachar A, Federle MP, Dodson SF (2001) Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology 218:68–74
Garignon C, Paparel P, Liloku R et al (2002) Mesenteric hernia: a rare cause of intestinal obstruction in children. J Pediatr Surg 37:1493–1494
Leape LL (1987) Patient care in Pediatric Surgery. Chap 23. Internal obstruction. Little, Brown, Boston
Morton JJ, Jones TB (1936) Obstruction about the mesentery in infants. Ann Surg 104:846–891
Ludwick JR, Constant E, Harrison TS (1967) Selective mucosal infarction of small bowel in incarcerated hernia. Arch Surg 94:871–875