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Internal hernia is a well-known complication of laparoscopic procedures, including Roux-en-Y gastric bypass. 1 Repair consists of retrograde reduction of the herniated small bowel and repair of the mesenteric defect. However, internal hernia requiring operative reduction after a laparoscopic colorectal operation is rarely reported, particularly in the case of restorative proctocolectomy; only one case has been previously reported in the literature.2 We present here a second case occurring at our institution.
A 27-year-old woman was well known to our institution as a result of a history of familial adenomatous polyposis with colonic adenocarcinoma. Aside from her gastrointestinal condition, she was otherwise healthy. She underwent laparoscopic total proctocolectomy with ileal pouch anal anastomosis (restorative proctocolectomy) and diverting loop ileostomy. She recuperated well from her first operation and underwent ileostomy takedown two months later. Three months after her uneventful ileostomy takedown, she presented acutely with a 48-hour history of crampy abdominal pain, nausea, and vomiting and a 24-hour history of obstipation. On examination, she had mild upper abdominal tenderness. Her laboratory evaluation was unremarkable, but her symptomatology and examination findings merited further investigation. Computed tomographic imaging indicated bowel herniation through an internal hernia defect (Fig. 1A-B) and the presence of a mesenteric ''swirl sign'' that was also highly suggestive of internal hernia (Fig. 1C-D). The patient was urgently taken to the operating...