Pseudo-herniation of small bowel

Published Date: 19th July 2016

Publication Authors: , Samad A

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Introduction:  A new potential space named as ‘Peritoneal Recess' was found during diagnostic laparoscopy performed to look for the cause of recurrent abdominal pain.

Case Report:  A middle aged patient presented with chronic abdominal pain without any obvious cause. All her investigations including small bowel studies were normal; however a recent CT scan raised the suspicion of an abdominal wall hernia. A diagnostic laparoscopy was performed to repair the CT detected hernia; though there was no obvious lump on examination. Laparoscopy revealed a left sided unilateral ‘Peritoneal Recess' formed by a fold of peritoneum, lying medial to linea-semilunaris and conforming to the curve of arcuate line for approximately 2.5 cm ending up in a blind recess (operative picturess taken). No extra-peritoneal sac or defect was noted neither in the rectus sheath nor any contents were present in the recess at the time of laparoscopy. By definition this is not a true hernia and we have named it as "Samad-Siddique's pseudo-hernia". The ‘Peritoneal Recess' was closed with laparoscopic tackers to prevent bowel from further entering the ‘Recess' which helped resolving the patient symptoms.

Conclusion:  The ‘Peritoneal Recess' may cause intermittent entrapment of small bowel resulting in chronic abdominal pain. We recommend diagnostic laparoscopy for confirmation followed by endoscopic fixation of the recess.

Siddique, K; Razi, K; Samad, A. (2013).  Anterior abdominal wall ‘peritoneal recess': Cause for pseudo-herniation of small bowel resulting in chronic abdominal pain . International Journal of Surgery. 11 (8), 615

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