Transmesenteric Internal Herniation Leading to Small Bowel Obstruction Postlaparoscopic Radical Nephrectomy

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.