[Internal hernia of the small intestine after laparoscopic nephrectomy]

The authors report the case of a woman operated by transperitoneal laparoscopic left nephrectomy for destroyed kidney. At the third postoperative week, she developed small bowel obstruction requiring reoperation by laparotomy. This complication was due to a transmesocolic internal hernia of the small intestine via a breach created during access to the renal pedicle by the peritoneal incision at the duodenojejunal flexure that was not closed. Four other cases of transmesocolic internal hernia have been reported in the literature following left laparoscopic nephrectomy. An accidental breach of the left mesocolon was considered to be responsible. This rare complication appears to be facilitated by creation of a mesocolic breach and by positioning the patient in the lateral supine position. These breaches must be closed.