Presentation
Chronic left abdominal pain post anterior resection.
Patient Data
As evidenced by the anastomosis in the pelvis, anterior resection had previously occurred. The mobilized descending colon is positioned mostly anterior and to the right, while some of the small bowel and its mesentery are positioned to the left.
Case Discussion
Although the herniation point was not definable in this case, those small bowel loops had herniated through the mesenteric defect into the back of the descending colon, which was thus displaced anteriorly to the right. This was confirmed at surgery.
After anterior resection, the descending colon becomes fairly mobile. Postoperatively, internal herniation of the small bowel loops through the mesenteric defect is common. Many patients are asymptomatic, some have chronic non-specific symptoms, and some present with acute bowel obstruction.
It can be hard to diagnose on imaging. The clue is the anterior and right-sided displacement of the descending colon and the left posterior displacement of small bowel loops.
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