eP462 - Small Bowel Obstruction Due to Open Mesenteric Defects After Ileocolic Resection: A Rarely Reported but Potentially Avoidable Complication

Purpose/Background: An ongoing debate revolves around the management of mesenteric defects following colectomy. Surgical practices vary, with some surgeons opting to close the mesenteric defect to mitigate the risk of internal hernia (estimated to occur at a rate of 0.8% of laparoscopic ileocolic resections), whereas many do not. It is noteworthy to highlight that certain surgeons may modify their decision regarding defect closure based on whether it is an open or laparoscopic operation. There is a lack of substantial, large-scale cohorts that can conclusively substantiate a recommendation to advocate for mesenteric defect closure as a preventive measure against internal hernia and its potentially catastrophic consequences.Methods/Interventions: We identified patients who underwent surgical intervention for small bowel obstruction resulting from an internal hernia after ileocolic anastomosis between 2009 and 2021 at our institution. This identification was facilitated by using a prospective database. Subsequently, patient data were comprehensively analyzed, focusing on the initial resection procedure, its indication, and short-term postoperative outcomes.Results/Outcomes: We identified 7 cases involving small bowel obstructions attributed to open mesenteric defects that necessitated emergency surgical intervention. Among these patients, five (71.4%) had previously undergone right ileocolic resection colectomy with ileocolonic anastomosis for colonic adenocarcinoma, one (14.2%) had a history of subtotal colectomy with ileorectal anastomosis for colitis, and one (14.2%) had undergone ileocolic resection for Crohn's disease; 5 (71%) of these index resections were performed laparoscopically. In terms of the reoperation for small bowel obstruction, all 7 (100%) patients required emergency laparotomy. The time between the initial surgery and small bowel obstruction ranged from 6 days to 86 months, with five 5 (71%) occurring greater than a 1-year after the index operation. Among these patients, three 3 (42.50 %) required small bowel resection, two (28.5%) underwent ileostomy creation, and one (14.2%) required admission to the intensive care unit. The average hospitalization duration for these cases was 12.5 days. No 30-day mortality was observed.Conclusion/

Discussion: This case series highlights 7 cases of small bowel obstruction, requiring laparotomy for small bowel obstruction due to internal hernia through mesenteric defects, that was left open at the index ileocolic resection. Although this complication is very rare, it always necessitates an emergent surgical intervention, potentially leading to small bowel resection, stoma creation, and prolonged hospitalization. Closing the mesenteric defect may prevent this morbid and potentially avoidable complication.