Internal hernia

Intestinal adhesion, the most frequent cause of bowel obstruction, cannot be demonstrated on sonography. Likewise, internal hernia and congenital fibrotic band can rarely be identified at sonography. Previous history of abdominal operation in patients without a sonographically visible cause of obstruction can lead to a diagnosis of adhesive ileus. 

Fig. 5.6a,b. Paraduodenal internal hernia, a Oblique scan above the umbilicus shows the zone of transition (arrow) between dilated and non-dilated bowel, b Transverse scan to the left of zone of transition shows the cluster of crowded and compressed loops of bowel as if they are tightly packed within a sac (arrows)... 

Ghahremani GG (1984) Internal abdominal hernias. Surg Clin North Am 64 393-406... 

Traditional use A decoction of the fruits is drunk to remove kidney and bladder stones. The seeds, taken internally, are leconunended to treat hernias in children and are smoked to treat syphilis (Khalmatov 1964). 

Current available stainless steel sutures are twisted multifilament Flexon and monofilament Stainless Steel from Covidien, monofilament Surgical Stainless Steel from Ethicon, twisted multifilament or monument Steelex from B. Braun, and monofilament or multifilament Surusteel from SURU International. Steel-based sutures have been used in closure of stern, skin, hernia, abdominal, and intestine. Edlich et al. (2006) reported a very good review of the performance of steel sutures in wound closure. 

For many years, textile structures have been successfully used for wound treatment, operations and implants. The popular range of these products include plasters, wound gauze, dressing material, surgical stitch material, vessel prosthesis and hernia nets. There is a differentiation between external and internal (implant) application. Most products are woven or knitted textile materials, which, for the various applications, are made up according to individual requirements. Figure 12.1 illustrates an embroidered stent. 

Fig. 15.15a-c. Muscle hernia, a-c Transverse 12-5 MHz US images obtained with different degrees of probe pressure over the defect show disruption of the tibialis anterior muscle fascia (open arrowhead) from the tibia (T) and subsequent muscle herniation within the subcutaneous tissue asterisks). Note progressive reduction of the herniation with graded compression. White arrowhead indicates the internal aponeurosis of the tibialis anterior muscle... 

Breakdown of suture lines and leakage are a common complication of the early postoperative phase. Afferent loop syndrome is a specific problem of Billroth II procedures and is caused by mechanical obstruction usually from adhesions. Internal hernias, extrinsic compression, bowel stenosis may also occur. Bezoar formation in the gastric remnant, anastomotic ulcers, incisional hernia of the abdominal wall and hiatal hernia are all also potential complications. Stenosis of the gastrojejunostomy after Billroth II procedures leads to obstruction (Fig. 13.14). Fistula after Billroth II is rare (Fig. 13.15). Tumour of the gastric renmant can be due to recurrence or present as a primary carcinoma of the stump (Fig. 13.16). 

---