A Case Report of Intramesosigmoid Hernia Treated with Laparoscopy

Michiaki Watanabe, Norio Mitsumori, Atsuo Shida, Tatsuya Yoshida^*, Tomotaro Shinoda^*, Susumu Kawano^*, Takeshi Kurihara^*, Takenori Hada^* and Yoji Yamazaki

Department of Surgery, The Jikei University School of Medicine
^*Department of Surgery, Kanagawa Prefectural Atsugi Hospital

A 68-year-old man admitted with a 3-day history of lower abdominal pain and nausea but no history of abdominal surgery and or other relevant history. No external hernia was found on physical examination. Dilated small intestine and air-fluid levels were found in abdominal radiography. No findings of strangulation ileus were seen. Small bowel obstruction was diagnosed and a long tube was emplaced to decompress the bowel. After 5 days, a radiographic study of the small bowel showed obstruction of the jejunum in the lower left quadrant, suggesting an internal hernia, further indicated by computed tomography, although the exact origin was unclear. Laparoscopic surgery was conducted after 15 days of follow-up because the patient was in stable condition but had still passed no flatus per rectum. A jejunal obstruction secondary to an internal hernia was the cause of the obstruction. A 10-cm loop of jejunum was found to be incarcerated in an oval defect on the lateral leaf of the mesosigmoid. The loop was reduced laparoscopically and seemed viable. This is the 59th case of internal hernia involving the mesosigmoid reported in Japan and the 8th of intramesosigmoid hernia whose orifice opened on the lateral leaf. Laparoscopic surgery is indicated for internal hernias in patients in good general condition, as our case illusttates. An establishment of a guideline of laparoscopic surgery for bowel obstructions, including internal hernia, is expected.

Key words
mesosigmoid, internal hernia, laparoscopy

Reprint requests
Michiaki Watanabe Department of Surgery, Jikei Uniersity, School of Medicine 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461 JAPAN

Accepted
December 18, 2002

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