Internal Hernia Resulting in Bowel Obstruction After Laparoscopic Colectomy
Yasunori Yoshimoto, MD, PhD, Akira Tanaka, MD, PhD, Toshihiro Abe, MD, PhD, Takahisa Fujikawa, MD, PhD, Norihiro Shimoike, MD, Seiichiro Tada, MD, Hisatsugu Maekawa, MD, Mitsuo Nishiyama, MD
Kokura Memorial Hospital, Department of Surgery, Kitakyushu, Fukuoka, Japan (all authors).
A 65-year-old woman underwent laparoscopic-assisted sigmoidectomy for management of sigmoid colon cancer. Her postoperative recovery was initially uneventful; however, on postoperative day 12, the patient suddenly complained of abdominal pain. Further surgical intervention was finally performed on postoperative day 21 because conservative treatment had been unsuccessful in relieving the obstruction. Laparoscopic surgery revealed that a segment of the proximal jejunum had herniated through an orifice, forming an adhesion between the mesentery of the ileum and the incised retroperitoneum of the mesenteric opening. The obstruction was relieved by laparoscopic adhesiolysis. Only 7 cases have previously been reported where the mesenteric opening has caused an internal hernia resulting in bowel obstruction. This case may suggest the need for closure of the mesenteric opening to prevent this complication after laparoscopic colectomy; however, there is no consensus on whether a mesenteric opening should be closed. Further research is needed to identify the patients who would benefit from the closure of mesenteric defects during laparoscopic-assisted colectomy.
Key Words: Internal hernia, Laparoscopic surgery, Small-bowel obstruction.