A Case of Laparoscopy-assisted Repair for an Intramesosigmoid Hernia

Abstract

An 85-year-old woman visited her doctor because of acute onset of abdominal pain after breakfast. Contrast-enhanced computed tomography showed dilation, a beak sign in the pelvis, and part of the small intestine with lower contrast. A strangulating intestinal obstruction was diagnosed. The patient was referred to our hospital and an emergency exploratory laparoscopy was performed. An oval defect 5cm in diameter was observed in the right sigmoid mesocolon, and part of the small intestine approximately 30cm in length was trapped in the defect. After the small intestine was pulled out of the defect, about 50cm was resected during the laparotomy, including the 30-cm ischemic part. A functional end-to-end anastomosis and additional incision to the defect was performed. The patient was discharged on the 10th postoperative day without complications. Intramesosigmoid hernias are rare, and preoperative diagnosis is difficult, but laparoscopy is useful for both diagnosis and treatment.