Abstract：
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.
摘要：
经肠系膜内疝是小肠梗阻的罕见原因，当小肠环通过肠系膜缺损突出到腹腔时发生。在这里，我们介绍了一个意外的结肠镜检查引起的肠系膜内疝病例。一名出现间歇性便血和便秘的81岁男性患者接受了腹腔镜左肾切除术治疗输尿管癌。进行结肠镜检查以确定其症状的病因。尽管内镜手术顺利，但他在检查后2小时抱怨严重腹痛，包括冷圈套器息肉切除术。对比增强计算机断层扫描显示肠梗阻，在降结肠外形成闭环。小肠环嵌在左腹膜后间隙中。急诊剖腹探查发现小肠loop通过下行肠系膜缺损脱垂到肾切除术蒂，在腹腔镜左肾切除术期间发展。嵌顿的小肠从疝气中脱离并恢复到正常位置,肠系膜缺损闭合。他表现出平稳的术后过程，出院后无腹内疝复发。这种情况表明，应牢记因无意中造成的肠系膜缺损而发生肠系膜内疝的风险，尤其是在接受腹腔镜肾切除术的患者进行结肠镜检查时。
