ABSTRACT
Objective: Laparoscopic colectomy has gained acceptance as a standard treatment for benign and malignant colorectal disease, such as diverticular disease and cancer, among others. Same as in open surgery, the laparoscopic approach carries a low risk of small bowel obstruction in the postoperative period, but in laparoscopic surgery, internal hernia after laparoscopic left colectomy may be a cause of small bowel obstruction with a significant risk of morbidity and mortality. This rare complication may be prevented with routine closure of the mesenteric defects created during the colectomy. Methods: We present four cases of internal herniation after laparoscopic colectomy. Two cases were after laparoscopic left colectomy and two after laparoscopic low anterior resection. All four cases had full splenic flexure mobilization. Routine closure of the mesenteric defect was not performed in the initial surgery. Results: The four patients were treated by laparoscopic reintervention with closure of the mesenteric defect. In two of them, conversion to open surgery was necessary. One of the patients developed recurrent internal herniation after surgical reintervention with mesenteric closure of the defect. All patients were managed without need for bowel resection, and mortality rate was 0%. Conclusion Internal herniation after laparoscopic colorectal surgery is a highly morbid complication that requires prompt diagnosis and management and should be suspected in the early postoperative period. Additional studies with extended follow-up are required to establish recommendations regarding its prevention and management. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Laparoscopy/adverse effects , Colectomy , Internal Hernia/etiology , Ileostomy , Conversion to Open Surgery , Internal Hernia/diagnostic imagingABSTRACT
RESUMEN Las hernias internas constituyen una causa rara de obstrucción de intestino delgado. Entre estas se encuentra la hernia transmesentérica congénita, que es muy infrecuente en adultos. Presentamos el caso de un paciente de sexo masculino de 20 años, sin antecedentes quirúrgicos ni traumáticos, que acudió al Servicio de Urgencias con sintomatología de obstrucción intestinal. Se realizó laparotomía de emergencia, encontrándose intestino delgado encarcelado a través de un defecto localizado en mesenterio yeyunal distal. No había necrosis intestinal por lo que no fue necesaria la resección intestinal. El paciente evolucionó favorablemente y fue dado de alta al tercer día posoperatorio.
ABSTRACT Internal hernias are a rare cause of bowel obstruction. Congenital transmesenteric hernias, a type of internal hernias, are uncommon in adults. We report the case of a 20-year-old male patient with no history of surgeries or trauma who presented to the emergency department with symptoms of bowel obstruction. Emergency laparotomy revealed small bowel incarceration through a defect in the distal jejunal mesentery. As the bowel was viable there was no need to perform bowel resection. The patient evolved with favorable outcome and was discharged on postoperative day 3.
Subject(s)
Humans , Male , Adult , Young Adult , Internal Hernia/surgery , Intestinal Obstruction/surgery , Abdominal Pain , Internal Hernia/diagnosis , Intestinal Obstruction/diagnostic imaging , LaparotomyABSTRACT
Intestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923. Intestinal malrotation is a rare condition among adults - prevalent in a mere 0.0001% to 0.19% of the population -, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptomsmay appear later in life,making diagnosis in adults difficult on account of non-specific symptoms. In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina. (AU)