A Case of Intramesosigmoid Hernia Diagnosed by Computed Tomography and Treated with Laparoscope

Abstract

A 56-year-old man with no past illness or operation complained of acute abdominal pain and nausea. Computed tomography showed small bowel obstruction in the left lower quadrant and incarcerated intestine behind the sigmoid colon. His illness was diagnosed as an ileus due to the sigmoid mesocolon hernia. We performed a laparoscopic operation after decompression of small bowel obstruction by the long tube. About 15cm of small intestine was incarcerated into a mesenteric defect 3cm in diameter of the left leaf of the sigmoid colon. By pulling the intestine, incarceration was removed. But the serosa of intestine was torn by this maneuver. Because of limited working space, it was difficult to repair the serosal tear of the intestine under laparoscope. We made a 5cm incision at left lower abdomen and repaired the serosal tear of intestine. The hernia orifice was sutured. We consider the sigmoid mesocolon hernia can be diagnosed by computed tomography and good candidate for the laparoscopic surgery. Including our case, 91 cases of the sigmoid mesocolon hernia have been reported in Japan.