Strangulated Pericecal Internal Hernia –Two Case Reports

Abstract

A Pericecal hernia is a relatively uncommon form of internal hernia, accounting for only 6-13% of all cases of abdominal internal hernias. It presents with clinical symptoms that closely resemble appendicitis, often causing severe lower abdominal pain and potential complications. This type of hernia occurs due to a defect in the mesentery of the cecum, which can be either congenital or acquired. The most prevalent subtype of Pericecal hernia is the retrocecal hernia, where ileal loops herniate through a defect in the cecal mesentery and the right paracolic gutter. These hernias typically develop within one of four peritoneal fossae: the superior ileo-cecal, inferior ileo-cecal, retro-cecal, and paracolic sulci. Pericecal hernias are also referred to as ileo-colic, retrocecal, ileocecal, or paracecal hernias. Diagnosis of a Pericecal hernia is often made through abdominal CT scans, which reveal a cluster of bowel loops, typically ileal, located posteriorly and laterally to the normal cecum, extending into the right paracolic gutter. These hernias can lead to small bowel obstruction and displace the cecum anteriorly and medially. Early diagnosis and surgical intervention are crucial to prevent complications. We present two cases of Pericecal internal hernia: one involving a 9-year-old boy and the other a 35-year-old male patient. Both patients exhibited symptoms of small bowel obstruction. Abdominal CT scans confirmed the presence of a Pericecal hernia with a strangulated small bowel. Exploratory laparotomy revealed the strangulated Pericecal hernia, which was successfully treated through manual hernia reduction and repair of the mesenteric defect.