Laparoscopic reduction of intersigmoid hernia: early surgical intervention for a rare form of internal hernia

Intersigmoid hernia is a rare form of internal hernia presenting with symptoms of bowel obstruction. A 32-year-old male visited the emergency department with chief complaint of abrupt onset of abdominal pain without any history of prior abdominal surgery. The initial abdominal X-ray and computed tomography (CT) scan exhibited mild distension of small bowel and paralytic ileus with no definitive obstruction site. However, a 12-h follow-up abdominal X-ray showed manifestations of newly appeared step-ladder sign and the CT scan displayed mechanical obstruction in the left lower quadrant area. Upon laparoscopic examination, herniation of small bowel was observed through the intersigmoid recess. Reduction was performed for about 5 cm of incarcerated ileum, and there was no sign of necrosis or lasting damage. The patient was discharged without complications. Laparoscopic management of intersigmoid hernia is possible with early surgical management of mechanical obstruction.