Internal Hernia Associated with Colostomy After Laparoscopic Surgery for Rectal Malignancy: A Report of 3 Thought-Provoking Cases

Abstract

Case seriesPatients: Male, 70 • Male, 75 • Male, 85Final Diagnosis: Internal herniaSymptoms: Abdominal and/or epigastric painMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Diagnostic/therapeutic accidentsBackground:Colostomy creation via intraperitoneal route is often performed during laparoscopic Hartmann’s operation or abdominoperineal resection (APR). Herein, we report 3 rare cases of internal hernia associated with colostomy (IHAC).Case Reports:The first case involved a 70-year-old man with IHAC after laparoscopic APR. Laparoscopy revealed the small intestine passed through a defect between the lifted sigmoid colon and left lateral abdominal wall in a cranialto-caudal direction. The dislocated bowel with ischemic change was restored to its normal position and the lateral defect was covered with lateral peritoneum and greater omentum. The second case involved a 75-year-old man with IHAC after laparoscopic APR. Intraperitoneal findings were similar to those in the first case, except for the size of the lateral defect. This defect was too large for primary closure or patching; therefore, no surgical repair was performed. Unfortunately, this led to IHAC recurrence and creation of a new colostomy via extraperitoneal route. The third case involved an 85-year-old man with acute peritonitis resulting from IHAC after laparoscopic Hartmann’s operation. Surgery revealed incarcerated bowels forming a closed loop and a perforation in the lifted sigmoid colon. The perforated colon was compressed by the dilated herniated bowel. The resected sigmoid colon showed perforation at the ulcer, which was shown on pathology to be caused by ischemia.Conclusions:IHAC can lead not only to ischemia of strangulated bowel, but also to secondary damage to the lifted colon. During laparoscopic Hartmann’s operation or APR, the colostomy should be created via extraperitoneal route to avoid IHAC.

Rare strangulated intenal hernia following extraperitoneal colostomy for rectal cancer operation: A case report

“…The main cause of intestinal obstruction is postoperative intra-abdominal adhesion, and few cases are caused by internal hernia after colorectal surgery [ 5 , 6 ]. When a single-hole colostomy is performed during APR or Hartmann surgery, there are cases of internal hernia in the lateral space of the stoma created through the intraperitoneal route [ 1 , 7 ]. To prevent internal hernias after colostomy, Goligher performed stoma construction via the extraperitoneal route to avoid the occurrence of internal hernias [ 8 ].…”

“…To prevent internal hernias after colostomy, Goligher performed stoma construction via the extraperitoneal route to avoid the occurrence of internal hernias [ 8 ]. In other case, Yasukawa et al suggested creating an extraperitoneal colostomy and closing the cranial orifice [ 1 ].…”

“…When a permanent colostomy is created laparoscopically, some institutions use the extraperitoneal route because some patients experience an internal hernia from the head to the outside of the stomas created through the intraperitoneal route [ 1 ]. In this case, we experienced an unusual internal hernia from the caudal lateral side of the elevated sigmoid colon, even though we created a stoma through the extraperitoneal route during laparoscopic abdominoperineal resection (APR).…”

Internal hernia of the stomach associated with colostomy after laparoscopic surgery for rectal cancer: a case report

“…In open and laparoscopic colostomy creations, the incidence rate of IHAC was approximately 1.5%. All IHACs were observed in laparoscopic colostomy performed via the intraperitoneal route [4]. With the intraperitoneal route, the small intestine can pass through the lateral defect, and the IHAC may result in strangulation ileus and severe ischemia.…”

“…Major causes of postoperative intestinal obstruction are intraperitoneal adhesions and torsion. There have been few reports of intestinal obstruction resulting from internal hernia associated with colostomy (IHAC) [4]. In addition, there are several reports about parastomal hernia containing the stomach [5].…”