Small bowel internal hernia post anterior resection
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
Updates to Case Attributes
TheAlthough the herniation point was not definable in this case, those small bowel loops had herniated through the mesenteric defect into the back of the descending colon, which was thus displaced anteriorly to the right. This was confirmed at surgery.
After anterior resection, the descending colon becomes fairly mobile after anterior resection. InternalPostoperatively, internal herniation of the small bowel loops through the mesenteric defect is common postop. Many patients are asymptomatic. Some, some have chronic nonspecificnon-specific symptoms. Some, and some present with acute bowel obstruction.
It can be hard to diagnose on imaging. The clue is the anterior and right-sided displacement of the descending colon, and the left posterior displacement of small bowel loops.
-<p>The descending colon becomes fairly mobile after anterior resection. Internal herniation of the small bowel loops through the mesenteric defect is common postop. Many patients are asymptomatic. Some have chronic nonspecific symptoms. Some present with acute obstruction.</p><p>It can be hard to diagnose on imaging. The clue is anterior and right-sided displacement of descending colon, and left posterior displacement of small bowel loops.</p>- +<p>Although the herniation point was not definable in this case, those small bowel loops had herniated through the mesenteric defect into the back of the descending colon, which was thus displaced anteriorly to the right. This was confirmed at surgery.</p><p>After <a href="/articles/anterior-resection-of-the-rectum" title="Anterior resection of the rectum">anterior resection</a>, the descending colon becomes fairly mobile. Postoperatively, <a href="/articles/internal-hernia" title="Internal herniation">internal herniation</a> of the small bowel loops through the mesenteric defect is common. Many patients are asymptomatic, some have chronic non-specific symptoms, and some present with acute bowel obstruction.</p><p>It can be hard to diagnose on imaging. The clue is the anterior and right-sided displacement of the descending colon and the left posterior displacement of small bowel loops.</p>
References changed:
- Portale G, Pedon S, Rettore C et al. Internal Hernia Following Laparoscopic Anterior Resection for Cancer: Higher Prevalence Than Expected of an Under-Reported Complication. Int J Colorectal Dis. 2021;37(2):331-5. <a href="https://doi.org/10.1007/s00384-021-04044-z">doi:10.1007/s00384-021-04044-z</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/34766204">Pubmed</a>
- Däster S, Xiang H, Yang J, Rowe D, Keshava A, Rickard M. High Prevalence of Asymptomatic Internal Hernias After Laparoscopic Anterior Resection in a Retrospective Analysis of Postoperative Computed Tomography. Int J Colorectal Dis. 2020;35(5):929-32. <a href="https://doi.org/10.1007/s00384-020-03537-7">doi:10.1007/s00384-020-03537-7</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32095872">Pubmed</a>
- Portale G, Pedon S, Rettore C, Cipollari C, Zuin M, Spolverato Y, Cancian L, Fiscon V. Internal hernia following laparoscopic anterior resection for cancer: higher prevalence than expected of an under-reported complication. Int J Colorectal Dis. 2022 Feb;37(2):331-335. doi: 10.1007/s00384-021-04044-z. Epub 2021 Nov 11. PMID: 34766204.
- Däster S, Xiang H, Yang J, Rowe D, Keshava A, Rickard MJFX. High prevalence of asymptomatic internal hernias after laparoscopic anterior resection in a retrospective analysis of postoperative computed tomography. Int J Colorectal Dis. 2020 May;35(5):929-932. doi: 10.1007/s00384-020-03537-7. Epub 2020 Feb 24. PMID: 32095872.
Updates to Study Attributes
There had been prior anterior resection, asAs evidenced by the pelvic anastomosisanastomosis in the pelvis, anterior resection had previously occurred. The mobilised descending colon was is positioned mostly anterior and to the right. Some, while some of the small bowel and its mesentery wereare positioned to the left.
Although the herniation point is not clearly-definable, those small bowel loops had actually herniated through the mesenteric defect into back of the descending colon which was thus displaced anteriorly to the right. This was confirmed at surgery.
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