Internal hernia caused by exposed structures after laparoscopic lateral lymph node dissection for rectal cancer: A...

Internal hernias secondary to exposed structures after lateral lymph node dissection (LLND) for rectal cancer are rare. A 53-year-old man who underwent laparoscopic ultra-low anterior resection and bilateral LND presented to our emergency department with sudden-onset severe abdominal pain and vomiting. Computed tomography demonstrated a closed loop obstruction of the intestine in the right lateral pelvic cavity and a significantly dilated small bowel in the abdominal cavity. Laparoscopic surgery revealed small bowel migration into the space between the right ureter and umbilical artery. The herniated bowel was laparoscopically reduced, and the small bowel exhibited no ischemic changes. Meanwhile, the hernial orifice was left unrepaired. The patient was discharged on the seventh postoperative day without complications. An internal hernia caused by exposed structures after lymphadenectomy should be a differential diagnosis in patients who have undergone LLND for rectal cancer and then present with severe abdominal pain and vomiting.