Internal hernia following laparoscopic colorectal surgery: a rare but fatal complication
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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.
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.
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.
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.
KeywordsInternal hernia Colorectal cancer Complication
Compliance with ethical standards
Conflict of interest
The authors received no financial support for this study. The authors (SYL, CHK, YJK, and HRK) declare no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
- 2.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 CrossRefPubMedGoogle Scholar
- 6.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 CrossRefPubMedGoogle Scholar
- 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):1644–1655CrossRefPubMedGoogle Scholar
- 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 CrossRefPubMedGoogle Scholar
- 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 CrossRefPubMedPubMedCentralGoogle Scholar