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Scholars Journal of Medical Case Reports | Volume-14 | Issue-11
Primary Internal Hernia Causing Small Bowel Obstruction in a 57-Year-Old Woman with A Virgin Abdomen: A Case Report and Review of the Literature
Benjelloune Kenza Touimi, El Mjabber Marwa, Berrada Othmane, Bouali Ichrak, Ettaoussi Abdelhak, Majd Abdessamad, Kamal Khadija, Bouali Mounir, El Bakouri Abdelilah, El Hattabi Khalid
Published: Nov. 3, 2026 |
14
11
Pages: 2444-2447
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Abstract
Introduction. Internal hernia (IH) is a rare cause of small bowel obstruction (SBO) that can progress rapidly to strangulation and is hard to diagnose in a virgin abdomen. Case presentation. A 57-year-old woman with no medical or surgical history presented with two days of obstipation, without pain or vomiting. Transit resumed spontaneously after one day. A first CT showed SBO with a transition zone in the right iliac fossa, and a second CT showed persistent obstruction by agglutinated loops enclosed in a pseudo-sac with mesenteric convergence, suggesting an IH. Laparoscopy found a sac-enclosed cluster of small bowel loops 70 cm from the ileocecal junction. Dissection was unsafe and the procedure was converted to laparotomy, with repair of the hernia and biopsy of the sac, which showed fibro-inflammatory tissue. The bowel was viable, no resection was needed, and recovery was uneventful. Conclusion. IH should be considered in any adult with SBO and no surgical history, even when symptoms regress. Persistent clustered loops with a pseudo-sac on repeat CT justify early exploration, and conversion is appropriate when laparoscopic dissection is unsafe.