Lessons learnt in the management of paraduodenal hernias: a case series.

INTRODUCTION: Paraduodenal hernias (PDH) are rare congenital internal hernias with non- specific symptoms. Left-sided paraduodenal hernia is three times more common than right-sided paraduodenal hernia with similar clinical presentation but different embryological origins. MATERIALS AND METHODS: We report a series of eight cases of paraduodenal hernia who presented with varied clinical presentation ranging from vague abdominal pain to complete intestinal obstruction. Six cases had left-sided paraduodenal hernia, while two cases had right-sided paraduodenal hernia. RESULTS: Seven cases based on their presentation underwent surgery either electively or on emergent basis. Three cases underwent laparoscopic repair. One case had a recurrence and was re-operated four months later. There was no mortality among any of the cases. CONCLUSION: A pre-operative diagnosis of paraduodenal hernia is essential. Laparoscopic surgery is safe in select cases and is found to be beneficial.

Diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias: a retrospective study.

INTRODUCTION: To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. METHODS: A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. RESULTS: Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with "cross sign" as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. DISCUSSION: IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.

A novel technique for NO.253 lymph node dissection and left colic artery preservation to avoid potential postoperative internal hernia in laparoscopic radical resection for rectal cancer.

BACKGROUND: The preservation of the left colic artery (LCA) has emerged as a preferred approach in laparoscopic radical resection for rectal cancer. However, preserving the LCA while simultaneously dissecting the NO.253 lymph node can create a mesenteric defect between the inferior mesenteric artery (IMA), the LCA, and the inferior mesenteric vein (IMV). This defect could act as a potential "hernia ring," increasing the risk of developing an internal hernia after surgery. The objective of this study was to introduce a novel technique designed to mitigate the risk of internal hernia by filling mesenteric defects with autologous tissue. METHODS: This new technique was performed on eighteen patients with rectal cancer between January 2022 and June 2022. First of all, dissected the lymphatic fatty tissue on the main trunk of IMA from its origin until the LCA and sigmoid artery (SA) or superior rectal artery (SRA) were exposed and then NO.253 lymph node was dissected between the IMA, LCA and IMV. Next, the SRA or SRA and IMV were sequentially ligated and cut off at an appropriate location away from the "hernia ring" to preserve the connective tissue between the "hernia ring" and retroperitoneum. Finally, after mobilization of distal sigmoid, on the lateral side of IMV, the descending colon was mobilized cephalad. Patients'preoperative baseline characteristics and intraoperative, postoperative complications were examined. RESULTS: All patients' potential "hernia rings" were closed successfully with our new technique. The median operative time was 195 min, and the median intraoperative blood loss was 55 ml (interquartile range 30-90). The total harvested lymph nodes was 13.0(range12-19). The median times to first flatus and liquid diet intake were both 3.0 days. The median number of postoperative hospital days was 8.0 days. One patient had an injury to marginal arterial arch, and after mobolization of splenic region, tension-free anastomosis was achieved. No other severe postoperative complications such as abdominal infection, anastomotic leakage, or bleeding were observed. CONCLUSIONS: This technique is both safe and effective for filling the mesenteric defect, potentially reducing the risk of internal hernia following laparoscopic NO.253 lymph node dissection and preservation of the left colic artery in rectal cancer surgeries.

Internal hernia trends following gastric bypass surgery.

BACKGROUND: Internal hernia is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGB), with reported rates ~ 5% within three months to three years after surgery. Internal hernia through a mesenteric defect can lead to small bowel obstruction. Mesenteric defects began to be more routinely closed, often considered standard practice by 2010. To our knowledge, there are no large population-based studies looking at rates of internal hernia post-LRYGB. This study utilizes a statewide database to characterize the trends of internal hernia post-LRYGB over the last two decades in multiple centers. METHODS: LRYGB procedure records between January 2005 and September 2015 were extracted from the New York SPARCS database. Exclusion criteria included age < 18, in-hospital deaths, bariatric revision procedures, and internal hernia repair during the same hospitalization as LRYGB. Time to internal hernia was calculated from initial LRYGB hospital stay to admission date of the first internal hernia repair record. A multivariable proportional sub-distribution hazards model was utilized to analyze the trend of internal hernia incidence within three-year post-LRYGB. RESULTS: 46,918 patients were identified between 2005 and 2015, with 2950 (6.29) undergoing internal hernia repair post-LRYGB by the end of 2018. The cumulative incidence of internal hernia repair at the 3rd-year post-LRYGB was 4.80% (95% CI: 4.59%-5.02%). By the end of the 13th year, the longest follow-up period, the cumulative incidence was 12.00% (95% CI: 11.30%-12.70%). Overall, there was a decreasing trend over time of undergoing internal hernia repair within three-year post-LRYGB (HR = 0.94, 95% CI: 0.93-0.96), after adjusting for confounding factors. CONCLUSION: This multicenter study maintains the rate of internal hernia following LRYGB reported in smaller studies and provides a longer follow-up period demonstrating decreasing occurrences of internal hernia after bypass as a function of year of index operation. This data is important as internal hernia continues to be a complication post-LRYGB.

Surgical treatment of internal hernia after Roux-en-Y gastric bypass - impact of institutional standards and surgical approach.

INTRODUCTION: Internal hernia is one of the most frequent long-term complications after laparoscopic gastric bypass surgery (RYGB). Surgical treatment of an internal hernia itself has risks that can largely be avoided by the implementation of institutional standards and a structured approach. MATERIAL AND METHODS: From 2012 until 2022, we extracted all consecutive bariatric cases from the prospectively collected national database (StuDoQ). Data from all patients undergoing internal hernia repair were then collected from our hospital information management system and retrospectively analyzed. We compared patient characteristics and surgical outcome of patients before and after the implementation of standard operating procedures for institutional and perioperative aspects (first vs. second time span). RESULTS: Overall, 37 patients were identified (median age 43 years, 86.5% female). Internal hernia was diagnosed after substantial weight loss (17.2 kg/m2) and on average about 34 months after RYGB. Baseline characteristics (age, sex, BMI, achieved total weight loss% and time interval to index surgery were comparable between the two groups). After local standardization, the conversion rate decreased from 52.6 to 5.6% (p = 0.007); duration of surgery from 92 to 39 min (p = 0.003), and length of stay from 7.7 to 2.8 days (p = 0.019). CONCLUSION: In this study, we could demonstrate that the surgical therapy of internal hernia after gastric bypass can be significantly improved by implementing institutional and surgical standards. The details described (including a video) may provide valuable information for non-specialized surgeons to avoid pitfalls and improve surgical outcomes.

Bowel obstruction by sigmoid strangulation as complication after laparoscopic adjustable gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been widely performed in the past, however, given its limited weight loss compared to some other procedures, this technique is less often used. Furthermore, a number of complications leading to band removal have been reported in the past few years. METHODS: We present a late acute bowel obstruction by sigmoid strangulation in a female patient with the LAGB performed 15 years ago. RESULTS: The laparoscopic exploration displayed a post-LAGB intestinal strangulation of the sigmoid loop which was caused by the connecting tube. Since the bowel was still viable, the tube was cut and the obstruction has been successfully resolved. The patient was discharged three days after the surgery. CONCLUSION: Although less often performed, knowledge of LAGB complications can be of importance. We believe that, the present strangulation of the sigmoid by the LAGB tubing is the world's first ever case reported. Nevertheless, when it is still proposed to selected patients, an adequate length of the intra-abdominal tubing could reduce the risk of loop formation and prevent this kind of obstruction by internal hernia.

Congenital Transmesenteric Hernia - A Rare Presentation.

Congenital transmesenteric defect is a rare but serious condition which presents a diagnostic challenge as symptoms and investigations are nonspecific. Here, we present a case with fetal ascites and dilated bowel loops who underwent intervention within 6 h of birth. Laparotomy showed volvulus and gangrene of 45 cm of the distal ileum, which was herniating through mesenteric defect. Timely detection and intervention can help in preventing significant morbidity and mortality. Given the downside to delay of surgical intervention and lack of specific tests, open exploration continues to be the only way to establish a definitive diagnosis of a transmesenteric hernia.

A rare case of abdominal cocoon associated with internal hernia in an adult.

A transmesenteric internal hernia (TIH) is a protrusion of a viscus through the mesenteric defect. It is secondary to previous gastrointestinal surgery in an adult. Early diagnosis and management are warranted to prevent the strangulation of the bowel in a TIH. Here, we are reporting a case of a 24-year-old gentleman with COVID-positive status who has presented with cough, abdominal cocoon, and features of subacute intestinal obstruction (SAIO) without any previous history of abdominal surgery. A nonoperative trial is given in the management of abdominal cocoon with SAIO. In contrast, delay in surgical intervention in TIH leads to bowel gangrene. Surprisingly even on contrast-enhanced computed tomography of the abdomen, TIH was not picked up. We have diagnosed this case intraoperatively with gangrene of the bowel. In an abdominal cocoon without any history suggestive of tuberculosis or previous surgery, or any other condition that leads to an intra-abdominal reaction, an internal hernia should be kept as a differential diagnosis. The delay in diagnosis and surgical intervention is associated with potentially disastrous complications.

[Giant traumatic diaphragmatic hernia as a complication after laparoscopic liver surgery]. / Gigantskaya travmaticheskaya diafragmal'naya gryzha kak oslozhnenie posle laparoskopicheskoi operatsii na pecheni.

Laparoscopic surgery is now one of the main options for patients with surgical diseases of abdominal cavity, pelvis and retroperitoneal space. Postoperative complications are known, and methods for their prevention after such interventions are well developed. However, there are rare complications, and their management deserves a special attention. The authors present a patient with giant traumatic hernia in long-term period after laparoscopic liver surgery. Clinical manifestations of disease are retrospectively analyzed. The authors discuss surgical aspects of treatment, i.e. choice of access, repair of diaphragmatic defect and peculiarities of postoperative period associated with non-anatomic return of abdominal organs through the diaphragmatic defect. This report will be useful for radiologists, thoracic and abdominal surgeons, anesthesiologists and intensive care specialists.

Computed tomography findings of intersigmoid hernia.

Purpose: To evaluate the computed tomography findings of intersigmoid hernias. Material and methods: Between April 2010 and March 2018, 7 patients who were surgically diagnosed with intersigmoid hernia in 3 institutions were enrolled in this study. Two radiologists evaluated imaging findings for the herniated small bowel, the distance between the occlusion point and bifurcation of the left common iliac artery, and the anatomic relationship with adjacent organs. Results: All patients were male, and their mean age (standard deviation, range) was 61.0 (13.5, 36-85) years. The mean size of the bowel loops was 5.2 (1.3, 4.0-8.3) cm in the caudal direction, 3.6 (0.8, 2.5-5.1) cm in the lateral, and 3.4 (0.6, 2.5-4.7) cm in the anterior-posterior direction. The volume was 37.9 (27.8, 15.6-103.0) cm3 approximated by an ellipse, and 24.0 (17.7, 9.9-65.6) cm3 approximated by a truncated cone. The obstruction point was located 3.6 (0.6, 2.8-4.7) cm inferior to the bifurcation of the left common iliac artery. In all cases, the small bowel ran under the point at which the inferior mesenteric vessels bifurcated to the superior rectal vessels and the sigmoid vessels and formed a sac-like appearance between the left psoas muscle and the sigmoid colon. The ureter ran dorsal to the point of the bowel stenosis, and the left gonadal vein ran outside the small bowel loops. Conclusions: All cases showed common imaging findings, which may be characteristic of men's intersigmoid hernia. In addition, the fossa's position was lower, and the size was larger than in the previous study, which may be a risk factor.

Internal hernia caused by bridge formation between the medial and lateral segments of the liver: a case report.

BACKGROUND: Despite numerous reports on ischemic bowel obstruction caused by internal hernia, no case presentation has been reported of an internal hernia caused by a bridge formed between the medial and lateral zones of the liver. Herein, we report the first case of ischemic bowel obstruction caused by a hepatic bridge. CASE PRESENTATION: A 24-year-old man complaining of abdominal pain was referred to our hospital and admitted. Computed tomography showed formation of a closed loop of small bowel with a hernia orifice near the hilar region, and poor contrast of the prolapsed small bowel. We suspected ischemic bowel obstruction caused by an internal hernia with a fissure of the greater omentum as the hernia orifice, and performed emergency surgery. Laparoscopic observation revealed that the medial and lateral segments of the liver formed a bridge on the dorsal side at the liver portal, and that the small intestine was ischemic in the gap created between the bridge and the medial and lateral liver segments. A Meckel's diverticulum was also invaginated in the gap. The bridge was dissected out and the hernia orifice was opened to release the bowel obstruction. The small bowel was preserved and the Meckel's diverticulum was resected. The patient's postoperative course was uneventful. CONCLUSIONS: We experienced a case of ischemic bowel obstruction caused by hepatic bridge formation, which was successfully treated by laparoscopic surgery.

Internal hernia following laparoscopic anterior resection for cancer: higher prevalence than expected of an under-reported complication.

BACKGROUND: Internal hernia (IH) after laparoscopic colorectal surgery is a potentially severe complication. It may go undiagnosed in patients having their abdominal CT scan during oncologic follow-up. We evaluated the occurrence of IH on CT scans after laparoscopic curative resection for rectal cancer (LRRC) and routine closure of the mesenteric defect. METHODS: Data from 189 consecutive patients undergoing elective curative LRRC in a 14-year period (June 2005-june 2019) were prospectively collected. Only patients with abdominal CT scans, performed as routine oncologic follow-up, between 3 months and 7 years post-operatively were included in the study and reviewed by a surgeon and a radiologist. RESULTS: A total of 161 patients were eligible for the study with a median age of 69 years (IQR: 59-77) at surgery. They had abdominal follow-up CT scans at a median of 39.5 months (IQR: 12.8-62.7) after surgery. The prevalence of IH was 11.2% (18/161 patients). Of the 18 patients, 15 (83.3%) were fully asymptomatic, 2 (11.1%) reported chronic abdominal discomfort (including mostly nausea and colicky pain) during their oncologic follow-up (however, IH was not suspected neither prompted additional investigations), and 1 (5.6%) was reoperated elsewhere for IH and acute small bowel obstruction. CONCLUSIONS: IH following LRRC is not uncommon, with a prevalence > 10% in our experience. Most of these patients remain fully asymptomatic, but in a few patients, IH might be responsible for some symptoms or require reoperation. Awareness of this complication is important, given the potential risk of acute small bowel obstruction.

Chylous ascites in the setting of internal hernia: a reassuring sign.

BACKGROUND: Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. METHODS: Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. RESULTS: Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001). CONCLUSIONS: Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect.

Current status of internal hernia after gastrectomy for gastric cancer.

BACKGROUND: Internal hernia is a well-known postoperative complication after Roux-en-Y gastric bypass. However, it has not been considered a recognized complication for gastric cancer. METHODS: We reviewed the literature in the past decade to clarify the current status of internal hernia after gastrectomy including its incidence, high-risk factors, and treatment. RESULTS: The incidence of internal hernia after gastrectomy was found to be between 0.2 and 5.63%, and the median interval time was less than 2 years. High-risk factors include laparoscopic approach, non-closure of all the mesenteric defects, and Roux-en-Y reconstruction. The rate of bowel resection was significantly higher than that of adhesive small bowel obstruction. CONCLUSION: The true incidence of internal hernia after gastrectomy is generally underestimated. Closure of all the mesenteric defects is one of the most effective methods to prevent postoperative internal hernia. Early surgical exploration is necessary when internal hernia is suspected.

Primary defect of ileal mesentery presenting as internal herniation and strangulation of the small bowel: Case report.

Primary internal hernia is a rare entity of acute intestinal obstruction. Delay in diagnosis and surgical intervention can cause ischaemia or gangrene of the small bowel and result in high morbidity and mortality. A 14-year-old boy presented to the emergency department with acute intestinal obstruction. On exploration, 3-4cm mesenteric defect was noted in the ileal region. Strangulated loops of the small bowel had gone through the mesenteric defect in a complicated way. Primary anastomosis was done after resection of the gangrenous small bowel.

Incarcerated left paraduodenal hernia case report and literature review.

INTRODUCTION: Left paraduodenal hernia is an internal herniation that develops due to anomalous fetal development. If incarcerated, it becomes an unusual cause of acute abdomen. CASE REPORT: This case report presents an uncommon case of a 39-year-old man with acute abdominal pain with vomiting. The patients medical history included recurrent subileous events and Crohn´s disease in long-term remission. CT scan of abdominal cavity indicated a possible mechanical obstruction of small bowel loops in the upper left abdominal quadrant. Incarcerated left paraduodenal herniation was identified during surgery. Repositioned small bowel loops did not require resection and the entrance of Landzert´s fossa was sutured. CONCLUSION: Left paraduodenal hernia is the most common congenital internal herniation. Although rare, it should be considered in the differential diagnosis of acute abdomen.

Allen-Masters syndrome as a cause of status ileus - case report.

INTRODUCTION: Internal hernias are rare and are encountered in a small percentage of cases. The hernia in the broad ligament of uterus (Allen-Masters syndrome) is a unique type of internal hernia which represents only approximately 4% of all internal hernias. CASE REPORT: We present the case of a 39-year-old woman admitted for clinical signs of mechanical bowel obstruction. CT examination revealed a dilated loop of small intestine in the left lower abdomen. The patient underwent laparoscopic surgery with the finding of an incarcerated small bowel loop in the ligamentum latum uteri. Small bowel deliberation and ligament defect suture were performed. CONCLUSION: A defect in the ligamentum latum uteri (Allen-Masters syndrome) is a rare diagnosis, usually discovered as an incidental finding in female patients with ileus. This syndrome may explain the vague problems of many patients whose symptoms include dyspareunia, dysmenorrhea, acute and chronic pelvic pain. Allen-Masters syndrome can be diagnosed and successfully managed by laparoscopic approach.

Small bowel obstruction and strangulation secondary to an adhesive internal hernia post ESWL for right ureteral calculi: a case report and review of literature.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is a relatively safe and convenient mode of treatment for ureteral and renal stones, despite its relative safety; ESWL is not without its complications. We present a case of a patient we managed for small bowel obstruction and strangulation due to an adhesive internal hernia after ESWL was done because of right ureteral calculi. CASE PRESENTATION: We report a case of a 59-year-old patient who presented with severe abdominal pain a few hours after ESWL because of a right upper ureteric calculus. The abdominal pain increased in severity in time and became more generalized. The patient had one episode of gross hematochezia as she was being prepped for emergency laparotomy. Intra-op, she had a strangulated internal hernia because of an omental-mesenteric adhesion. CONCLUSION: This case report hopes to highlight the potential of complications like acquired IH due to adhesions in patients with a history of ureteral calculi, and also the complications that may come about post-ESWL. Patients who present with signs of persistent abdominal pain post-ESWL should be vigilantly observed. If symptoms persist, increase in intensity or there is a general deterioration of the patients' hemodynamic status, even in light of negative MDCT findings, prompt surgical intervention is crucial for definitive diagnosis as well as management.

Robotic "Double Loop" Roux-en-Y gastric bypass reduces the risk of postoperative internal hernias: a prospective observational study.

BACKGROUND: Internal herniation (IH) is a potentially serious complication after laparoscopic Roux-en-Y gastric bypass (RYGB). The aim of the study is to evaluate the incidence of IH after robot-assisted RYGB (RA-RYGB) performed with the "Double Loop" technique at our Institution. METHODS: Prospective cohort study of patients submitted to RA-RYGB with the "Double Loop" technique, with a minimum follow-up of 2 years. Patients with complaints of abdominal pain at clinical visits or entering the emergency department were evaluated. Primary outcome was the incidence of IH, defined as the presence of herniated bowel through a mesenteric defect, diagnosed at imaging or at surgical exploration. RESULTS: A total of 129 patients were included: 65 (50.4%) were primary procedures, while 64 (49.6%) were revisional operations after primary restrictive bariatric surgery. Mean age was 47.9 ± 10.2 years, mean weight, and body mass index were, respectively, 105.3 ± 22.6 kg and 39.7 ± 9.6 kg/m2. Postoperative morbidity rate was 7.0%. Mean follow-up was 53.2 ± 22.6 (range 24-94) months. During the follow-up period, a total of 14 (10.8%) patients entered the emergency department: 1 patient had melena, 4 renal colic, 1 acute cholecystitis, 2 gynecologic pathologies, 2 anastomotic ulcers, 1 perforated gastric ulcer, 1 diverticulitis and 2 gastroenteritis. There were no diagnoses of IH. During the follow-up period, no patient experienced recurrence of symptoms. CONCLUSIONS: In the present study, the robotic approach confirms the low complication rate and absence of IH after "Double Loop" RA-RYGB in a large case-series at a medium-term follow-up.

Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients.

BACKGROUND: Internal hernia (IH) is an infrequent complication following colorectal resection with minimally invasive technique. The real prevalence is difficult to define and there are only few large series reporting data on this complication, often focusing only on left-sided resections. Aim of the study was to evaluate the occurrence of IH following laparoscopic colorectal resection (LCR), reporting clinical presentation and treatment. METHODS: Data from 1297 patients undergoing elective LCR for cancer or benign disease in a 15-year period (June 2005-March 2020) were prospectively collected. A database query was performed to search for small bowel obstructions requiring reintervention. RESULTS: Five patients presented symptomatic IH (prevalence = 0.38%) and required reintervention. The preceding surgical procedure was left hemicolectomy for diverticular disease in all patients. The mesenteric defect had been originally closed in 4/5 patients. The median time interval between initial surgery and the occurrence of IH was 1 (range: 0.3-10) month. In all cases a small bowel loop was found herniating through the mesocolic defect. Small bowel resection was required in one patient only. The median hospital stay following reintervention was 7 (range: 4-17) days. CONCLUSIONS: IH following LCR is a rare but severe complication, potentially leading to death, if not promptly diagnosed and treated. Awareness of this complication, early recognition, and proper diagnostic and therapeutic management is mandatory allowing laparoscopic approach and often avoiding small bowel resection.