VM25 - Internal Hernia Following Colo-Rectal Anastomosis

Saturday, June 1, 2024

10:00 AM – 1:30 PM ET, USA

Location: Baltimore Convention Center, Hall BCD

Senior Author(s)

ZJ

Ziyad Jabaji, MD

Assistant Professor
Loma Linda University
Monrovia, California, United States

Disclosure information not submitted.

Author(s)

ND

Nicole DePolo, MD

Resident Physician
Loma Linda University
Redlands, California, United States

Disclosure information not submitted.

Video Presentation(s)

Lisa Manzanete

Medical Student
Loma Linda University School of Medicine
Loma Linda University School of Medicine
Loma Linda, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

HC

Hannah Curtis, B.S.

Medical Student
Loma Linda University School of Medicine
Orange, California, United States

Disclosure information not submitted.
AA

Allison A. Aka, MD

Assistant Professor
Loma Linda University
Loma Linda, California, United States

Disclosure information not submitted.

Purpose/Background: A 35yr old patient underwent a Hartmann's procedure for perforated diverticulitis elsewhere and was referred for colostomy reversal. Following laparoscopic colostomy closure he experienced cyclical episodes of distention, abdominal pain, and constipation followed by sudden and unpredictable bowel movements. Colonoscopy ruled out an anastomotic stricture. CT scan demonstrated an internal hernia of small bowel under the mobilized descending colon.

Methods/Interventions: The patient was explored laparoscopically. The hernia was reduced, and the mesenteric defect was closed. We illustrate relevant points both in evaluation of the pre-operative CT, as well as technical considerations such as optimal exposure of the hernia, retroperitoneal exploration to identify the ureter, excising a portion of the neoperitonealized Gerota's fascia (akin to resecting hernia sac), and how to laparoscopically suture near the aorta.

Results/Outcomes: The patient was discharged on post-op day 1 following laparoscopic reduction and closure of his internal hernia. His symptoms completely resolved by the time of follow-up.

Conclusion/Discussion: Care should be taken when constructing left sided anastomoses to exclude the small bowel from under the cut edge of the descending colon mesentery to avoid this complication. Careful attention should be paid to persistent abdominal symptoms and workup should be scrutinized for mechanical complications before assigning a more routine diagnosis such as functional constipation. The complication of internal hernia following colo-rectal anastomosis can be safely managed with minimally invasive techniques.