Iatrogenic Internal Hernia as a Cause of Small Bowel Ischemia During Pregnancy

Background: Internal hernia, a rare surgical complication, can cause intestinal obstruction. Pregnancy may complicate the timely clinical diagnosis. Case: A 39-year-old woman was referred at 28 weeks' gestation for diffuse abdominal pain and vomiting, 18 years after having had a jejunostomy. Abdominal ultrasonography showed dilated small bowel loops with thickening of the bowel wall to 7mm and free fluid in moderate amount. Laparotomy revealed an internal hernia with an incarcerated 1.5mnecrotic distal small bowel. The necrotic bowel segment was resected en bloc and a side-to-side primary ileal anastomosis was performed. The hernial orifice at the mesointestine was sutured to prevent recurrence of bowel herniation. On the third postoperative day an urgent cesarean section was performed because of the onset of heavy vaginal bleeding subsequent to placental separation. Conclusions: Internal hernia should be included in the differential diagnosis of small bowel obstruction during pregnancy, especially when the clinical history includes previous abdominal operations. Early surgical exploration is important because of the risk of fetal and maternal morbidity and mortality.