Two cases of an internal hernia after laparoscopic sigmoid resection

Two patients with a laparoscopic resection of the sigmoid colon in their surgical history were diagnosed with an internal hernia because of a mesenteric gap underneath the descending neocolon. While the first case demonstrated a strongly symptomatic patient with a closed-loop obstruction of the small bowel, the second case was less obvious and correct diagnosis was achieved after a few weeks by finally performing a diagnostic laparoscopy. Since internal hernias after laparoscopic sigmoid resection are a rare complication and as presented in the second case can display very unspecific symptoms, the surgeon's awareness is not immediately raised towards it. Therefore, an asymptomatic internal hernia bears a constant risk of a life-threatening outcome allowing to recommend an initial closure of the mesenteric gap. In both cases, successful treatment was achieved by surgery and intraoperatively closing the remaining mesenteric gap. Subsequently recovery and follow-up were uneventful.