A Case of Internal Hernia Which Occurred Through a Mesenteric Defect After Laparoscopic Partial Colectomy

Abstract

The patient was an 87-year-old man who underwent laparoscopic partial colectomy with D2 lymph node dissection and intracorporeal overlap anastomosis for MALT lymphoma of the transverse colon. He returned on postoperative day 14 complaining of abdominal pain. We diagnosed the patient as having strangulated small bowel obstruction based on the findings of contrast-enhanced CT, and took him up for emergency surgery. Strangulation of the proximal jejunum that had herniated through an unclosed mesenteric defect at the site of the colonic anastomosis, functioning as a hernia orifice, was observed. The necrotic bowel was resected and reconstructed by handsewn end-to-end anastomosis. The mesenteric defect was covered by suturing the proximal jejunum onto the orifice. Internal herniation through a mesenteric defect after colectomy is a rare, but recognized, complication. In our case, multiple factors, such as D2 lymph node dissection and intracorporeal overlap anastomosis with minimal mobilization of the colon resulting in a small mesenteric defect led to an increased risk of strangulation of the internal hernia contents. Mesenteric defect closure after colectomy is necessary in select cases, depending on the location of the colectomy and the types of lymph node dissection and anastomosis.