Intersigmoid hernia

　　1. The etiology of intersigmoid hernia is unclear, and it is generally believed that the existence of the intersigmoid recess is the anatomical basis for its occurrence.

　　2. The intersigmoid recess is a gap formed by the insufficient fusion of the sigmoid colon mesentery with the posterior abdominal wall layer. Located on the left side of the root of the sigmoid colon mesentery, it is exactly at the root of the sigmoid colon in the shape of an inverted V, attached to the top of the posterior abdominal wall, presenting an upward funnel-shaped recess, with the mouth facing the lower left.

　　Intestinal obstruction (intestinal obstruction, ileus) refers to the obstruction of intestinal contents in the intestines. It is a common acute abdomen condition that can be caused by various factors. At the beginning of the disease, the obstructed intestinal segment has anatomical and functional changes first, followed by the loss of body fluids and electrolytes, intestinal wall circulation disorders, necrosis, and secondary infection. Finally, it can lead to sepsis, shock, and death. Of course, if diagnosed in time and treated actively, most cases can reverse the progression of the disease and be cured.

　　1. Recurrent episodes of episodic left lower abdominal pain, accompanied by nausea, vomiting, and bloating after meals. If complete intestinal obstruction occurs, the pain will intensify, changing from episodic to persistent, and there will be a stop in passing gas and defecation. Physical examination: palpable tender mass in the left lower abdomen, and hyperactive bowel sounds can be heard.

　　2. Although anatomically many people have 1 intersigmoid recess, the occurrence of intersigmoid hernia in clinical practice is extremely rare. According to a comprehensive literature report by Clemenz and Kemmerer (1967), there are only 34 cases recorded in the literature. This disease has no specific symptoms, and preoperative diagnosis is very difficult. Often, a diagnosis can only be made when an expanded small intestinal loop is found entering the intersigmoid recess during surgery. If the following conditions are met and other diseases are ruled out, intersigmoid hernia can be considered.

　　Avoid lifting, pushing, or pulling heavy objects; quit smoking or smoke as little as possible, as the cough of smokers may accelerate the development or deterioration of hernia, and quitting smoking can improve blood circulation and accelerate the recovery process; eat less food that is likely to cause constipation and abdominal bloating (especially cooked eggs, sweet potatoes, peanuts, beans, beer, carbonated beverages, etc.), and eat more high-fiber foods, including grains, cereals, bran, and unprocessed fruits and vegetables; drinking at least eight glasses of water daily can help relieve constipation; avoid and reduce sneezing; deep breathing can help alleviate chronic cough.

　　First, abdominal fluoroscopy or plain film:

　　Visible aggregated small intestine on the left or right side, dilated intestine with gas or fluid, and other signs of intestinal obstruction.

　　Second, gastrointestinal barium enema:

　　Helpful for the diagnosis of sigmoid colon interloop hernia, suitable only for patients without symptoms and signs of intestinal obstruction. Typical imaging:

　　1. The mass of small intestinal loops is aggregated on the left or right side of the abdomen, the intestine is not easy to separate, and the small intestinal mass does not move when pushed or the patient's position is changed, as if it is placed in a bag.

　　2. Barium moves slowly through the small intestine; there are very few small intestinal loops in the pelvic cavity, the terminal ileum is in a normal position, and the position of the colon and stomach is often changed. The characteristic imaging of sigmoid colon interloop hernia: small intestine agglomerates (hernia mass), located on the right abdomen, when the patient is standing, the stomach often hangs down to the left side of the small intestinal mass (hernia mass), the descending colon is on its left, and the ascending colon can be on its right, rear, front, or obliquely in the left anterior side.

　　1. Foods that are good for sigmoid colon interloop hernia:

　　Diet should be light. For the first few days after surgery, adjust the diet according to personal condition, mainly with liquid and semi-liquid foods, and eat more high-protein foods to promote wound healing. Supplement a variety of vitamins, eat more fresh vegetables and fruits. You can eat various lean meats, milk, eggs, and other foods rich in protein.

　　2. Foods to avoid for sigmoid colon interloop hernia:

　　Avoid foods that are too greasy. Foods such as fermented bean curd, scallions, chili peppers, chives, etc., are not conducive to wound healing because they are prone to cause infection.

　　This disease has no specific symptoms, and preoperative diagnosis is very difficult. It is often only possible to make a diagnosis when an expanded small intestinal loop enters the hidden recess between the sigmoid colon during surgical exploration. The surgical treatment principle for sigmoid colon interloop hernia is to realign the intestine and suture the hernia ring opening. Attention should be paid to avoid injury to the posterior pararenal left common iliac artery and vein and the left ureter when suturing the hernia ring opening.