Abstract
A 69-year-old woman who underwent umbilical hernia repair with mesh insertion in her 40s developed repeated bouts of bowel obstruction that needed hospitalizations over a short period and was considered to require surgery. Preoperative CT findings suggested that adhesion of the small intestine to the abdominal wall might cause the obstruction, but advanced kyphosis and her history of hernia surgery complicated detailed surgical planning. We therefore examined her further using a laparoscopic approach, which revealed that the abdominal wall was bent deeply toward the dorsal side and in contact with the mesentery due to the influence of kyphosis and the inserted mesh even under pneumoperitoneum. The small intestine was sandwiched firmly between the abdominal wall and the mesentery, from where bowel obstruction started. These findings indicated that not only intestinal repair, but also abdominal wall reconstruction was necessary, and partial resection of the small intestine, mesh removal and abdominal wall plastic surgery were proceeded later. Laparoscopic assessment was effective to determine a treatment strategy for a patient who had intestinal obstructions with complicated causes.
