Abstract
We report a case of internal hernia through a mesenteric defect after laparoscopic sigmoidectomy for early sigmoid colon cancer. A 66-year-old man operated on in June 2009 for early sigmoid colon cancer was admitted to our hospital with a sudden onset of abdominal pain. Physical examination disclosed abdominal distention with severe tenderness. A plain abdominal X-ray revealed a small amount of gas in the small intestine with air fluid levels. Abdominal enhanced computed tomography (CT) demonstrated small bowel distention oral to the narrowing around the site of the mesenteric defect with a small amount of ascites. Internal hernia through a mesenteric defect after laparoscopic sigmoidectomy was diagnosed and he underwent emergency laparotomy ; in which herniation and ischemia of the ileum 60 cm in length through a mesenteric defect of the sigmoid colon and a small amount of bloody ascites was identified. The herniated ileum was repositioned and resected, the mesenteric defect was closed. Although mesenteric defects are closed in open surgery, such management is not usually performed in laparoscopic surgery due to the technical difficulty. A literature review was also performed on closure of the mesenteric defect in laparoscopic bowel resection.
