A case report of strangulated ileus through a mesenteric defect after laparoscopic-assisted colectomy (lac)

Abstract

A 73-year-old woman, who had undergone laparoscopic-assisted sigmoidectomy for sigmoid colon cancer, presented with a sudden onset of lower abdominal pain and vomiting one year and nine months after the surgery. She was admitted to the hospital for conservative treatment but the symptoms progressed. Abdominal contrast-enhanced CT scan showed a strangulated ileus at the lower left quadrant of abdomen causing marked obstruction of the jejunum, and collection of ascites. Emergency surgery was thus performed with a diagnosis of postoperative strangulated ileus. Laparotomy revealed a strangulated ileus through a mesenteric defect which had not been closed in the previous operation. A necrotic ileum loop, ranging from 150 to 220cm distal to the Treitz's ligament, was resected.
Many surgeons including us tend to leave the mesenteric defect open in LAC. Repair of the defect after LAC is a matter of controversial opinion. Our experience as well as nine case reports of strangulated ileus after LAC might suggest that closure of the mesenteric defect could help preventing occurrence of post-operative strangulated ileus.