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1Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Abstract:
Internal herniation following laparoscopic surgery is rare. We present a case of small bowel obstruction secondary to internal herniation in a 76-year-old male patient. Presentation was on postoperative day 28 following transperitoneal laparoscopic radical left nephrectomy for suspected renal carcinoma. The herniation was through a defect in the large bowel mesentery identified at exploratory laparotomy. To date, 10 cases of internal herniation following laparoscopic nephrectomy have been described in the literature. Two cases were managed laparoscopically and the remainder by laparotomy. One case required resection of an ischaemic portion small bowel and the remainder were managed by reduction of the hernia and closure of the defect. Internal herniation is rare but carries significant morbidity. It must be considered in cases presenting with obstructive symptoms after laparoscopic nephrectomy. Early CT scanning and prompt surgical management are hallmarks of best management.
Insights
Internal herniation is a rare complication after laparoscopic surgery. This case highlights the importance of considering internal herniation in patients with obstructive symptoms post-laparoscopic nephrectomy for prompt diagnosis and management.
Area of Science:
- Urology
- Surgical Gastroenterology
- Abdominal Imaging
Background:
- Laparoscopic surgery, particularly nephrectomy, is increasingly common.
- Internal herniation is a rare but serious complication following abdominal surgery.
- Small bowel obstruction secondary to internal herniation presents a diagnostic challenge.
Observation:
- A 76-year-old male presented with small bowel obstruction 28 days post-laparoscopic radical left nephrectomy.
- Exploratory laparotomy revealed internal herniation through a defect in the large bowel mesentery.
- This represents the 11th reported case of internal herniation after laparoscopic nephrectomy.
Findings:
- Of 11 reported cases, 2 were managed laparoscopically and 9 via laparotomy.
- One patient required small bowel resection due to ischemia; others had hernia reduction and defect closure.
- Internal herniation following laparoscopic nephrectomy is associated with significant morbidity.
Implications:
- Internal herniation must be considered in the differential diagnosis of obstructive symptoms after laparoscopic nephrectomy.
- Early diagnosis via computed tomography (CT) scanning is crucial.
- Prompt surgical intervention is essential for optimal patient outcomes and to minimize complications.
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