title: Bowel obstruction caused by an internal hernia that developed after laparoscopic subtotal colectomy: a case report.
abstract: BACKGROUND
  Laparoscopic surgery is a minimally invasive approach with good treatment outcomes and is currently the standard surgery for colorectal cancer in Japan. Mesenteric closure is considered unnecessary in laparoscopic colorectal surgery because it can damage the bowel and blood vessels. However, an internal hernia may develop if the mesentery is not repaired.
  
  
  METHODS
  We report a case of internal hernia in a 61-year-old male of Japanese ethnicity. The patient had advanced sigmoid colon cancer, early-stage transverse colon cancer, and multiple adenomatous polyposis, and underwent laparoscopically-assisted subtotal colectomy. Bowel obstruction developed six days postoperatively and did not improve with conservative treatment. Abdominal computed tomography detected an internal hernia, prompting emergency surgery in which the ileum protruding into the mesenteric defect and an anastomotic stricture were detected. Reanastomosis, mesentery closure, and ileostomy were performed after hernia repair.
  
  
  CONCLUSIONS
  In this case, open surgery was necessary due to bowel obstruction after laparoscopic colectomy. This outcome indicated that mesenteric closure should have been performed. Thus, the benefits of mesenteric closure require assessment in future cases.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka-ken 810-0023, Japan. yoshida_takefumi@med.kurume-u.ac.jp.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Kinugasa
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Oka
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Mizobe
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Mori
authors.forename: Taro
authors.initials: T
authors.lastname: Isobe
authors.forename: Eri
authors.initials: E
authors.lastname: Katayama
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Akagi
mesh_terms: D000714:Anastomosis, Surgical; D003082:Colectomy / Q000009:adverse effects*; D046449:Hernia, Abdominal / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007081:Ileostomy; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed