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Hernia                    DOI 10.1007/s10029-008-0424-7                1    CASE REPORT                2   Internal hernia...
Hernia               62   –   Computed tomography, abdomen: moderate dilatation               63       of small-bowel loop...
Hernia               125   the surgery of laparoscopic fundoplication that the patient              3. Gullino D, Giordano...
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Internal hernia through an iatrogenic perforation in the falciform ligament a case report.

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Internal hernia through an iatrogenic perforation in the falciform ligament a case report.

  1. 1. Dear Author,Here are the proofs of your article. • You can submit your corrections online or by fax. • For online submission please insert your corrections in the online correction form. Always indicate the line number to which the correction refers. • Please return your proof together with the permission to publish confirmation. • For fax submission, please ensure that your corrections are clearly legible. Use a fine black pen and write the correction in the margin, not too close to the edge of the page. • Remember to note the journal title, article number, and your name when sending your response via e-mail, fax or regular mail. • Check the metadata sheet to make sure that the header information, especially author names and the corresponding affiliations are correctly shown. • Check the questions that may have arisen during copy editing and insert your answers/ corrections. • Check that the text is complete and that all figures, tables and their legends are included. Also check the accuracy of special characters, equations, and electronic supplementary material if applicable. If necessary refer to the Edited manuscript. • The publication of inaccurate data such as dosages and units can have serious consequences. Please take particular care that all such details are correct. • Please do not make changes that involve only matters of style. We have generally introduced forms that follow the journal’s style. Substantial changes in content, e.g., new results, corrected values, title and authorship are not allowed without the approval of the responsible editor. In such a case, please contact the Editorial Office and return his/her consent together with the proof. • If we do not receive your corrections within 48 hours, we will send you a reminder.Please noteYour article will be published Online First approximately one week after receipt of your correctedproofs. This is the official first publication citable with the DOI. Further changes are, therefore,not possible.After online publication, subscribers (personal/institutional) to this journal will have access to thecomplete article via the DOI using the URL: http://dx.doi.org/[DOI].If you would like to know when your article has been published online, take advantage of our freealert service. For registration and further information go to: www.springerlink.com.Due to the electronic nature of the procedure, the manuscript and the original figures will only bereturned to you on special request. When you return your corrections, please inform us, if you wouldlike to have these documents returned.The printed version will follow in a forthcoming issue.
  2. 2. Fax to: +44 870 622 1325 (UK) or +44 870 762 8807 (UK)To: Springer Correction Team 6&7, 5th Street, Radhakrishnan Salai, Chennai, Tamil Nadu, India – 600004Re: Hernia DOI:10.1007/s10029-008-0424-7 Internal hernia through an iatrogenic defect in the falciform ligament: a case reportAuthors: M. Lakdawala · S.R. Chaube · Y. Kazi · A. Bhasker · A. KanchwalaPermission to publishI have checked the proofs of my article andq I have no corrections. The article is ready to be published without changes.q I have a few corrections. I am enclosing the following pages:q I have made many corrections. Enclosed is the complete article.Date / signature ______________________________________________________________________________
  3. 3. Metadata of the article that will be visualized in OnlineFirst Please note: Images will appear in color online but will be printed in black and white.ArticleTitle Internal hernia through an iatrogenic defect in the falciform ligament: a case reportArticle Sub-TitleArticle CopyRight - Year Springer-Verlag 2008 (This will be the copyright line in the final PDF)Journal Name HerniaCorresponding Author Family Name Chaube Particle Given Name S. R. Suffix Division Department of Minimal Invasive Surgery Organization Saifee Hospital Address Room no. 216, 2nd floor, 15/17, Maharishi Karve Road, Charni Road (East), 400004, Mumbai, India Email shalilchaube@gmail.comAuthor Family Name Lakdawala Particle Given Name M. Suffix Division Department of Minimal Invasive Surgery Organization Saifee Hospital Address Room no. 216, 2nd floor, 15/17, Maharishi Karve Road, Charni Road (East), 400004, Mumbai, India EmailAuthor Family Name Kazi Particle Given Name Y. Suffix Division Department of Minimal Invasive Surgery Organization Saifee Hospital Address Room no. 216, 2nd floor, 15/17, Maharishi Karve Road, Charni Road (East), 400004, Mumbai, India EmailAuthor Family Name Bhasker Particle Given Name A. Suffix Division Department of Minimal Invasive Surgery Organization Saifee Hospital Address Room no. 216, 2nd floor, 15/17, Maharishi Karve Road, Charni Road (East), 400004, Mumbai, India EmailAuthor Family Name Kanchwala
  4. 4. Particle Given Name A. Suffix Division Department of Minimal Invasive Surgery Organization Saifee Hospital Address Room no. 216, 2nd floor, 15/17, Maharishi Karve Road, Charni Road (East), 400004, Mumbai, India Email Received 16 June 2008Schedule Revised Accepted 31 July 2008Abstract The incidence of internal hernia through a defect in the falciform ligament, mostly congenital, is very rare. In this era of minimally invasive laparoscopic surgeries, a few cases of internal hernia through an iatrogenic defect in the falciform ligament have also been reported. Here, we present a case of a 65-year-old patient who presented with acute small-bowel obstruction. The patient had undergone a laparoscopic fundoplication 4 years ago. On diagnostic laparoscopy, it was found that the cause of the intestinal obstruction was herniation of the small bowel through a window in the falciform ligament (which was probably created due to port insertion during the previous surgery of laparoscopic fundoplication). The obstruction was relieved by the division of the falciform ligament.Keywords (separated by -) Internal hernia - Intestinal obstruction - Small-bowel obstruction - Falciform ligament - Iatrogenic etiologyFootnote Information
  5. 5. Hernia DOI 10.1007/s10029-008-0424-7 1 CASE REPORT 2 Internal hernia through an iatrogenic defect in the falciform 3 ligament: a case report 4 M. Lakdawala S. R. Chaube Y. Kazi F 5 A. Bhasker A. Kanchwala OOAuthor Proof 6 Received: 16 June 2008 / Accepted: 31 July 2008 7 Ó Springer-Verlag 2008 PR 8 Abstract The incidence of internal hernia through a internal small-bowel hernias occur due to iatrogenic mes- 32 9 defect in the falciform ligament, mostly congenital, is very enteric defects (i.e. Peterson’s, pseudo-Peterson’s etc.) 33 10 rare. In this era of minimally invasive laparoscopic sur- caused by previous surgeries. Here, we describe a case of 34 11 geries, a few cases of internal hernia through an iatrogenic internal hernia through an iatrogenic defect in the falciform 35 12 defect in the falciform ligament have also been reported. ligament which was diagnosed intra-operatively. 36 13 Here, we present a case of a 65-year-old patient who pre- ED 14 sented with acute small-bowel obstruction. The patient had 15 undergone a laparoscopic fundoplication 4 years ago. On Case report 37 16 diagnostic laparoscopy, it was found that the cause of the 17 intestinal obstruction was herniation of the small bowel A 65-year-old lady was admitted with complaints of: 38 18 through a window in the falciform ligament (which was CT 19 probably created due to port insertion during the previous – Sudden onset of continuous vomiting, 10–12 times, 39 20 surgery of laparoscopic fundoplication). The obstruction bilious, since 24 h 40 21 was relieved by the division of the falciform ligament. – Colicky abdominal pain 41 22 – Constipation 42 23 Keywords Internal hernia Á Intestinal obstruction Á – Central abdominal distension 43 E 24 Small-bowel obstruction Á Falciform ligament Á No other relevant contributory history, other than her 44 25 Iatrogenic etiology past history of laparoscopic fundoplication performed 45 RR 26 4 years ago for gastro-esophageal reflux disease. 46 The patient was previously asymptomatic until this 47 27 Introduction episode. 48 On examination, the patient had a pulse rate of 96/min 49 28 Internal hernia is an uncommon cause of small-bowel and blood pressure of 130/80 mmHg. 50 29 obstruction. Intestinal obstruction due to internal hernia is CO Per abdomen, abdominal distension was present. The 51 30 very dangerous. It may present either silently or with dull bowel sounds were hyper-peristaltic. 52 31 abdominal pain or with sudden acute abdominal pain. Most Per rectal examination was empty. 53 Other systemic examinations were normal. 54 Investigations: 55 UN A1 M. Lakdawala Á S. R. Chaube (&) Á Y. Kazi Á A. Bhasker Á – Complete blood count: normal 56 A2 A. Kanchwala – Routine biochemistry: normal 57 A3 Department of Minimal Invasive Surgery, – Electrolytes: normal 58 A4 Saifee Hospital, Room no. 216, 2nd floor, – X-ray, chest: normal 59 A5 15/17, Maharishi Karve Road, Charni Road (East), A6 Mumbai 400004, India – X-ray, abdominal: multiple air fluid levels and dis- 60 A7 e-mail: shalilchaube@gmail.com tended small-bowel loops 61 123 Journal : Large 10029 Dispatch : 16-8-2008 Pages : 3 Article No. : 424 h LE h TYPESET MS Code : 08 133 4 h CP 4 h DISK
  6. 6. Hernia 62 – Computed tomography, abdomen: moderate dilatation 63 of small-bowel loops 64 Treatment: 65 The patient was started on conservative management, 66 i.e. nil by mouth, nasogastric tube decompression and 67 intravenous fluids. However, she did not settle, even after 3 68 days of conservative treatment, so the decision for diag- 69 nostic laparoscopy to be performed was taken. 70 Findings of laparoscopy: F 71 – Distended small-bowel loops 72 – Few omental adhesions with the port site of previous OO 73 surgery 74 – Herniated small-bowel loop (Fig. 1) through a defect inAuthor Proof 75 the falciform ligament (which was probably created 76 due to port insertion during the previous surgery of 77 laparoscopic fundoplication) Fig. 2 Division of the falciform ligament PR 78 – The bowel was distended proximally with an abrupt 79 cut-off distally a pre-existing anatomic structure, such as the foramen of 91 80 – The rest of the bowel was not distended distally Winslow, or a pathological defect of congenital or acquired 92 81 – No other cause of intestinal obstruction was seen origin. Internal hernia is an infrequent cause of small- 93 bowel obstruction with a reported incidence of up to 5.8% 94 82 The falciform ligament was cut (Fig. 2) to release the of all cases of intestinal obstruction [6]. 95 83 herniated bowel loop. The different types of internal hernia and their relative 96 ED 84 The patient had an uneventful post-operative recovery. incidences [4] are: 97 – Paraduodenal (left [ right): 53% 98 85 Discussion – Foramen of Winslow: 8% 99 – Transmesenteric: 8% 100 CT 86 An internal hernia is defined as an abnormal protrusion of a – Transomental: 1–4% 101 87 viscus through a normal or abnormal opening within the – Pericaecal: 13% 102 88 boundaries of the peritoneal cavity. – Intersigmoid: 6% 103 89 The incidence [6] of internal hernias is 0.2–2%, and – Supravesical and pelvic: 6% 104 90 most of them are asymptomatic. The hernial orifice may be – Pelvic hernias include hernias through the broad 105 E ligament (4–5%), perirectal fossa and fossa of Douglas 106 Hernia through the falciform ligament is very rare and 107 RR accounts for 0.2% of internal hernias [7]. A congenital [2, 108 7] etiology for these defects is probable, attributable to 109 malformation and incomplete development of the falciform 110 ligament. 111 A study of the literature showed a few individual case 112 reports of internal hernia through congenital defects of the 113 CO falciform ligament. Gullino et al. [3] reported on a series of 114 14 cases of internal hernias, of which, two were hernias 115 through an anomalous orifice from the absence of the fal- 116 ciform ligament of the liver. In recent years, a few cases of 117 internal hernia through the falciform ligament, due to an 118 UN iatrogenic defect created post-laparoscopic surgery [1, 5], 119 has also been reported. 120 In the above-described case, the defect in the falciform 121 ligament did not appear to be congenital and could, prob- 122 Fig. 1 Herniated small bowel through a defect in the falciform ably, be attributed to the port placement and the port 123 ligament cannula being passed across the falciform ligament during 124 123 Journal : Large 10029 Dispatch : 16-8-2008 Pages : 3 Article No. : 424 h LE h TYPESET MS Code : 08 133 4 h CP 4 h DISK
  7. 7. Hernia 125 the surgery of laparoscopic fundoplication that the patient 3. Gullino D, Giordano O, Gullino E (1993) Internal hernia of the 134 126 had undergone in the past. abdomen. Apropos of 14 cases. J Chir (Paris) 130(4):179–195 135 4. Kohli A, Choudhury HS, Rajput D (2006) Internal hernia: a case 136 report. Ind J Radiol Imag 16(4):563–566 137 5. Malas MB, Katkhouda N (2002) Internal hernia as a complication 138 127 References of laparoscopic nissen fundoplication. Surg Laparosc Endosc 139 Percutan Tech 12(2):115–116 140 128 1. Charles A, Shaikh AA, Domingo S et al (2005) Falciform ligament 6. Zissin R, Hertz M, Gayer G et al (2005) Congenital internal hernia 141 129 hernia after laparoscopic cholecystectomy: a rare case and review as a cause of small bowel obstruction: CT findings in 11 adult 142 130 of the literature. Am Surg 71(4):359–361 patients. Br J Radiol 78:796–802 143 131 ` 2. Corberi O, Crespi G, Deho E et al (1979) Internal abdominal 7. Wiseman S (2000) Internal herniation through a defect in the 144 145 F 132 hernia caused by anomaly of the falciform ligament (a case report). falciform ligament: a case report and review of the world 133 Chir Ital 31(6):1354–1359 literature. Hernia 4(2):117–120 146 147 OOAuthor Proof PR ED E CT RR CO UN 123 Journal : Large 10029 Dispatch : 16-8-2008 Pages : 3 Article No. : 424 h LE h TYPESET MS Code : 08 133 4 h CP 4 h DISK

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