Internal hernia of the stomach through the lateral space of
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An 81-year-old woman had undergone laparoscopic abdominoperineal resection for rectal cancer. A permanent colostomy was created through an intraperitoneal route. Pathologically, the tumor was classified as pT2N0M0, and R0 resection was achieved.

Three months after the surgery, the patient presented with lower abdominal pain and vomiting. Contrast-enhanced computed tomography (CT) showed gastric incarceration through the space between the lifted sigmoid colostomy and the left lateral abdominal wall (Fig. 1a). Because the incarcerated stomach had no evidence of strangulation, conservative therapy with nasogastric tube decompression of the dilated stomach was administered. A CT on the next day showed the reduction of the stomach (Fig. 1b), and oral intake was started. However, the patient again began vomiting on the 7th and 13th days after admission, and a CT on the 13th day revealed recurrence of the gastric hernia.

A laparoscopic operation was performed for the recurrent hernia. Intraoperative findings showed that the gastric hernia had been reduced and ischemic changes were not evident in the stomach (Fig. 2a). Because the lateral defect of the lifted sigmoid colostomy was too large for suturing closure, a new colostomy was constructed laparoscopically through an extraperitoneal route (Fig. 2b). The patient’s postoperative course was uncomplicated, and she had no recurrence of hernia within the 20 months of follow-up after the surgery.

Source: https://academic.oup.com/jscr/article/2020/6/rjaa124/5862151
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