Laparoscopic Repair of Transmesosigmoid Hernia Following Robot-Assisted Abdominoperineal Resection: A Case Report

Abstract

Sigmoid mesocolon hernia is a rare type of internal hernia that can rapidly progress to vascular compromise, necrosis, and intestinal perforation. Therefore, rapid diagnosis and surgical treatment are important. We present a case of transmesosigmoid hernia following robot-assisted abdominoperineal resection that was successfully treated using a laparoscopic approach. An 80-year-old woman underwent robot-assisted abdominoperineal resection for anal canal cancer. The postoperative course was uneventful. Two months after the surgery, the patient presented with upper abdominal pain. Computed tomography revealed small bowel obstruction. We diagnosed the patient with strangulating intestinal obstruction and performed emergency laparoscopic surgery. Intraoperative findings revealed small intestinal strangulation and herniation through a defect in the sigmoid mesocolon. The strangulated intestine was released, and the defect was closed using barbed sutures. The patient was discharged on postoperative day 9 without complications. Intraoperative video from the previous surgery showed a small defect in the sigmoid mesocolon suspected to be the origin of the transmesosigmoid hernia. The defect may have formed during the medial approach using an electric scalpel. We emphasized the need for intraoperative vigilance when using energy devices during mesenteric dissection and any mesenteric defect created during surgical procedures should be promptly closed to prevent subsequent transmesenteric internal hernias.

Keywords: colorectal cancer; ileus; internal hernia; laparoscopic surgery; transmesosigmoid hernia.

Figure 1. CT findings.

a. Axial CT showing a sigmoid stoma in the left lower abdomen with a transition point (arrowhead) indicating small bowel obstruction. b. Coronal CT demonstrating a beak sign (arrowhead) at the site of obstruction, suggestive of a closed-loop obstruction. CT: computed tomography

Figure 2. Laparoscopic findings of the mesosigmoid hernia.

a. The small intestine is incarcerated within the orifice of the mesosigmoid hernia. b. The defect size measures approximately 3 cm. c. Retrospective review of the robotic surgery video revealed a small defect in the sigmoid mesocolon, likely the origin of the hernia, which went undetected at the time of the initial surgery.