POSTOPERATIVE DIAGNOSIS: Closed loop small bowel obstruction, secondary to an internal hernia in the right dorsal peritoneum.
Operation
Exploratory laparotomy with lysis of adhesions and release of bowel obstruction, with reduction of internal hernia.
Procedure/Description
...The peritoneal cavity was sharply entered. He had markedly dilated proximal small bowel loops. The diameter of the bowel approached 6 cm. The bowel was run and he was found to have a round internal hernia measuring approximately 5 cm in diameter in the right retroperitoneum. An approximately 25 cm segment of incarcerated, strangulated small bowel was reduced from that. The surface of the small bowel was erythematous and hemorrhagic, but the bowel was clearly viable and did peristalse normally. Its color became less and less congested and more and more normal with time...The neck of the retroperitoneal defect was then oversewn so that no further herniation would be possible..."