Top

Hernia

Published in:

01-04-2017 | Original Article

Internal hernia following laparoscopic colorectal surgery: a rare but fatal complication

Authors: S. Y. Lee, C. H. Kim, Y. J. Kim, H. R. Kim

Published in: Hernia | Issue 2/2017

Abstract

Purpose

Internal hernia of the small bowel through a mesenteric defect following colorectal cancer surgery is a serious but rarely reported complication. The aim of this study was to evaluate the incidence, clinical features, and management of these hernias.

Methods

We retrospectively reviewed 4589 primary colorectal cancer patients who underwent surgical resection between January 2007 and December 2015. The incidence, clinical presentations, and short-term outcomes of patients with symptomatic internal hernia following colorectal surgery were investigated in detail.

Results

We found 9 (0.2 %) patients who presented with symptomatic internal hernia. In all cases, preceding surgical procedures were laparoscopic anterior resection (n = 9), including low anterior resection (n = 3) and intersphincteric resection (n = 3). The median time interval between initial surgery and the occurrence of internal hernia was 4 months (range 5 days–27 months). Main symptoms were abdominal distension and pain; 4 (44.4 %) patients presented with systemic inflammatory response syndrome. Most cases (7/9, 77.8 %) were suspected of internal hernia by preoperative abdominal computed tomography. Six (66.6 %) patients underwent emergency surgery, after which all developed postoperative complications without mortality. The median hospital stay was 27.5 days (range 25–54 days) among patients who underwent surgical intervention.

Conclusions

Internal hernia following colorectal cancer surgery is a rare but potentially fatal complication, and as such, early recognition and management of these cases are important.

Trabaldo SS, Anvari M, Leroy J, Marescaux J (2009) Prevalence of internal hernias after laparoscopic colonic surgery. J Gastrointest Surg 13(6):1107–1110. doi:10.1007/s11605-009-0851-5 CrossRef

Lee SY, Park KJ, Ryoo SB, Oh HK, Choe EK, Heo SC (2014) Early postoperative small bowel obstruction is an independent risk factor for subsequent adhesive small bowel obstruction in patients undergoing open colectomy. World J Surg 38(11):3007–3014. doi:10.1007/s00268-014-2711-z CrossRefPubMed

Onopchenko A (2005) Radiological diagnosis of internal hernia after Roux-en-Y gastric bypass. Obes Surg 15(5):606–611. doi:10.1381/0960892053923806 CrossRefPubMed

Steele KE, Prokopowicz GP, Magnuson T, Lidor A, Schweitzer M (2008) Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach. Surg Endosc 22(9):2056–2061. doi:10.1007/s00464-008-9749-7 CrossRefPubMed

Miyagaki H, Takiguchi S, Kurokawa Y, Hirao M, Tamura S, Nishida T, Kimura Y, Fujiwara Y, Mori M, Doki Y (2012) Recent trend of internal hernia occurrence after gastrectomy for gastric cancer. World J Surg 36(4):851–857. doi:10.1007/s00268-012-1479-2 CrossRefPubMed

Yoshikawa K, Shimada M, Kurita N, Sato H, Iwata T, Higashijima J, Chikakiyo M, Nishi M, Kashihara H, Takasu C, Matsumoto N, Eto S (2014) Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Surg Endosc 28(6):1774–1778. doi:10.1007/s00464-013-3384-7 CrossRefPubMed

Elio A, Veronese E, Frigo F, Residori C, Salvato S, Orcalli F (1998) Ileal volvulus on internal hernia following left laparoscopic-assisted hemicolectomy. Surg Laparosc Endosc 8(6):477–478CrossRefPubMed

Kawamura YJ, Sunami E, Masaki T, Muto T (1999) Transmesenteric hernia after laparoscopic-assisted sigmoid colectomy. JSLS 3(1):79–81PubMedPubMedCentral

Blanc P, Delacoste F, Atger J (2003) A rare cause of intestinal obstruction after laparoscopic colectomy. Ann Chir 128(9):619–621CrossRefPubMed

10.

Saklani A, Naguib N, Tanner N, Moorhouse S, Davies CE, Masoud AG (2012) Internal herniation following laparoscopic left hemicolectomy: an underreported event. J Laparoendosc Adv Surg Tech A 22(5):496–500. doi:10.1089/lap.2011.0413 CrossRefPubMed

11.

Ansari N, Keshava A, Rickard MJ, Richardson GL (2013) Laparoscopic repair of internal hernia following laparoscopic anterior resection. Int J Colorectal Dis 28(12):1739–1741. doi:10.1007/s00384-013-1728-3 CrossRefPubMed

12.

Kim HJ, Kim CH, Lim SW, Huh JW, Kim YJ, Kim HR (2013) An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection. Colorectal Dis 15(2):e93–e98. doi:10.1111/codi.12056 CrossRefPubMed

13.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655CrossRefPubMed

14.

Daskalaki A, Kaimasidis G, Xenaki S, Athanasakis E, Chalkiadakis G (2015) Internal-mesocolic hernia after laparoscopic left colectomy report of case with late manifestation. Int J Surg Case Rep 6:88–91. doi:10.1016/j.ijscr.2014.11.067 CrossRef

15.

Martin LC, Merkle EM, Thompson WM (2006) Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol 186(3):703–717. doi:10.2214/ajr.05.0644 CrossRefPubMed

16.

Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ (2012) Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73(5 Suppl 4):S362–S369. doi:10.1097/TA.0b013e31827019de CrossRefPubMed

17.

Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandala V, Mandala S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F (2013) Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 8(1):42. doi:10.1186/1749-7922-8-42 CrossRefPubMedPubMedCentral

18.

Chu DI, Gainsbury ML, Howard LA, Stucchi AF, Becker JM (2013) Early versus late adhesiolysis for adhesive-related intestinal obstruction: a nationwide analysis of inpatient outcomes. J Gastrointest Surg 17(2):288–297. doi:10.1007/s11605-012-1953-z CrossRefPubMed

19.

Teixeira PG, Karamanos E, Talving P, Inaba K, Lam L, Demetriades D (2013) Early operation is associated with a survival benefit for patients with adhesive bowel obstruction. Ann Surg 258(3):459–465. doi:10.1097/SLA.0b013e3182a1b100 CrossRefPubMed

Title: Internal hernia following laparoscopic colorectal surgery: a rare but fatal complication
Authors: S. Y. Lee
C. H. Kim
Y. J. Kim
H. R. Kim
Publication date: 01-04-2017
Publisher: Springer Paris
Published in: Hernia / Issue 2/2017
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-016-1532-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Internal hernia following laparoscopic colorectal surgery: a rare but fatal complication

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2017

Tribute to Professor Andrew Kingsnorth

Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair

Abdominal wall reinforcement: biologic vs. degradable synthetic devices

Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study

Long-term results and complications related to Crurasoft® mesh repair for paraesophageal hiatal hernias

Risk factors for injuries associated with damage claims following groin hernia repair