Bowel obstruction caused by an internal hernia that developed after laparoscopic subtotal colectomy: a case report

Abstract

IntroductionLaparoscopic surgery is a minimally invasive approach with good treatment outcomes and is currently the standard surgery for colorectal cancer in Japan. Mesenteric closure is considered unnecessary in laparoscopic colorectal surgery because it can damage the bowel and blood vessels. However, an internal hernia may develop if the mesentery is not repaired.Case presentationWe report a case of internal hernia in a 61-year-old male of Japanese ethnicity. The patient had advanced sigmoid colon cancer, early-stage transverse colon cancer, and multiple adenomatous polyposis, and underwent laparoscopically-assisted subtotal colectomy. Bowel obstruction developed six days postoperatively and did not improve with conservative treatment. Abdominal computed tomography detected an internal hernia, prompting emergency surgery in which the ileum protruding into the mesenteric defect and an anastomotic stricture were detected. Reanastomosis, mesentery closure, and ileostomy were performed after hernia repair.ConclusionIn this case, open surgery was necessary due to bowel obstruction after laparoscopic colectomy. This outcome indicated that mesenteric closure should have been performed. Thus, the benefits of mesenteric closure require assessment in future cases.

The risk of internal hernia or volvulus after laparoscopic colorectal surgery: a systematic review

“…At re‐operation, the mesenteric defect was closed in 52.2% (12/23; 8 ns) of cases. Six mesenteric defects were closed with suture and six with fibrin glue to approximate the mesentery of the neo‐colon to the posterior peritoneum. While nonabsorbable sutures were recommended in several studies , only one study specified the type of suture used and this was an absorbable 3‐0 vicryl.…”

“…In four studies, the method of mesenteric defect closure at re-operation was continuous suturing [7][8][9][10]. In one study, fibrin glue was used in six cases [11].…”

Internal hernia following laparoscopic colorectal surgery: single center experience

“…Recently, some authors reported SBO due to IH after laparoscopic colorectal surgery (LCRS) (2)(3)(4)(5)(6). This rising trend can be seen because laparoscopic colorectal surgery is now performed commonly worldwide.…”

Internal hernia through mesocolon defect after left laparoscopic colectomy

“…22 However, it should be noted that, even taking this precaution, there are some cases of intestinal obstruction due to IH, similarly to occurred with the patient of the present report. 25,26 The precise diagnosis that an intestinal obstruction results from the development of an IH, begins with a careful clinical history. Importantly, the time to onset of symptoms between the initial surgery and the bowel obstruction may vary from hours to years.…”