2017 Volume 37 Issue 4 Pages 643-646
An 87-year-old woman underwent a laparoscopic distal gastrectomy for early gastric cancer. During the surgery, a part of the transverse mesocolon approximately 10 mm in diameter was injured, but we decided that restoration of this defect was not necessary because the injured area was tiny and was unlikely to cause complications. Three months after the surgery, the patient complained of nausea and underwent a computed tomography examination, which revealed an ileus caused by an internal hernia of the small intestine into the transverse mesocolon; emergency surgery was subsequently performed. Intraoperatively, a hernia orifice in the transverse mesocolon and invagination of the small intestine were observed. The invaginated intestine was withdrawn, and the hernia orifice of the mesocolon was closed with sutures. The internal hernia was shown to have been caused by mesenteric injury at the first surgery because the identified hernia orifice was at the same site as the mesenteric defect during the laparoscopic distal gastrectomy. It is very important to recognize that injury of the transverse mesocolon during surgery can lead to an internal hernia as a postoperative complication and that the repair of mesocolon damage is indeed required. Furthermore, precautions to avoid this complication should be taken.
