Intestinal obstruction from diaphragmatic hernia following colonoscopy

Transmesenteric internal hernia: an unexpected adverse event induced by colonoscopy

Transmesenteric internal hernia is an uncommon cause of small bowel obstruction that occurs when small bowel loops protrude through a mesenteric defect into the abdominal cavity. Herein, we present an unexpected case of colonoscopy-induced transmesenteric internal hernia. An 81-year-old male patient presenting with intermittent hematochezia and constipation had undergone a laparoscopic left nephrectomy for ureteral cancer. A colonoscopy was performed to identify the etiology of his symptoms. He complained of severe abdominal pain 2 h after the examination despite uneventful endoscopic procedures, including cold snare polypectomy. Contrast-enhanced computed tomography revealed a strangulated small bowel obstruction with a closed-loop formation outside the descending colon. The small bowel loop was incarcerated into the left retroperitoneal space. Emergency laparotomy detected small bowel loops that prolapsed into the nephrectomy pedicle via a descending mesenteric defect, developed during the laparoscopic left nephrectomy. The incarcerated small bowel was detached from the hernia and returned to its normal position, and the mesenteric defect was closed. He demonstrated an uneventful postoperative course, with no internal hernia recurrence after discharge. This case indicates the risk of transmesenteric internal hernia through inadvertently created mesenteric defects should be borne in mind, especially when performing colonoscopies in patients who underwent laparoscopic nephrectomies.

Laparoscopic repair of colonoscopy-induced adult Bochdalek hernia: Case report

Introduction

Bochdalek hernias are congenital diaphragmatic malformations caused by a failure to close the pleuroperitoneal cavity in the posterolateral area. Bochdalek hernias are very rare in adult, with congenital diaphragmatic defects being even rarer.

Presentation of case

A 35-year-old man presented to our emergency room with epigastric pain after colonoscopy. The patient had no history of trauma. Plain chest X-ray revealed bowel gas patterns and haziness in the left lower lung field. Abdominal computed tomography revealed a left diaphragmatic defect in the posterolateral area, with herniation of the omentum and colon. The patient successfully underwent laparoscopic herniorrhaphy.

Discussion

The diaphragm comprises fibrous tissue and muscle. Therefore, direct damage by a colonoscope is almost impossible. Normal chest X-ray as a part of a health screening was performed 9 days prior to admission, and the size of the diaphragmatic defect could be covered by the spleen; therefore, the patient was considered hernia-free for over 30 years.

Conclusion

We report a rare case of delayed Bochdalek hernia that may have been induced by the difficult insertion of a colonoscopy. Although rare, this disorder should be recognized, examined and treated appropriately to avoid complications.

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Bochdalek hernia found in adult is very rare.

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The small size of the diaphragm defect appears to have been blocked by the spleen.

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Herniation of colon was induced by the difficult insertion of a colonoscopy.

Diaphragmatic hernia as a rare complication of colonoscopy: Case report and literature review

RATIONALE

Diaphragmatic Hernia is rare as complication of Colonoscopy. Diaphragmatic hernia as a complication of colonoscopy has been reported only few cases. Additionally, it is often misdiagnosed as other disease by clinicians due to their lack of related knowledge, which delays diagnosis of Diaphragmatic hernia and thus exacerbates the prognosis.

PATIENT CONCERNS

We report the case of a 66-year-old man with fecal occult blood. In the case, sudden epigastric pain after colonoscopy owing to diaphragmatic hernia in a left hemidiaphragm.

DIAGNOSES

The diagnoses made by a CT scan without delay. It showed marked protrusion of the large bowel into the left thoracic cavity along with elevation of the left diaphragm.

INTERVENTIONS

The diaphragmatic defect was repaired by simple closure and intestinal adhesions release surgery.

OUTCOMES

Five days after surgery, the patient was discharged in good condition.

LESSONS

Most of diaphragmatic hernia is congenital with high mortality. However, there are a few cases of Diaphragmatic hernia caused by previous trauma or surgery. We herein report an unusual case of diaphragmatic hernia related to colonoscopy but usually life-threatening complication.