Laparoscopic Anterior Gastropexy with a Technical Modification Using the Round Ligament for Internal Hernia of the Stomach after Sigmoid Colostomy: A Case Report.

INTRODUCTION: Internal hernia involving the stomach associated with a sigmoid colostomy is extremely rare. The hernia defect is typically located between the colostomy limb and the left abdominal wall. Because only a few cases have been reported, no standardized management strategy has been established, particularly in patients in whom immediate colostomy closure is not appropriate.

CASE PRESENTATION: A woman in her 70s underwent a laparoscopic Hartmann's procedure with sigmoid colostomy for obstructive sigmoid colon cancer with para-aortic lymph node metastasis. On POD 9, the patient developed acute abdominal distension and vomiting. CT revealed marked gastric dilatation due to incarceration of the stomach in the space between the colostomy limb and the left lateral abdominal wall. Nasogastric decompression relieved the incarceration, and elective laparoscopic surgery was performed 4 days later to prevent recurrence. Because the remaining sigmoid colon was short and colostomy reconstruction would have required mobilization of the splenic flexure, anterior gastropexy was performed using a technical modification in which the prepyloric antrum was fixed to the round ligament of the liver, while the gastric body was fixed to the upper abdominal wall using nonabsorbable barbed sutures. The postoperative course was uneventful. The patient subsequently received systemic chemotherapy, followed by para-aortic lymph node dissection, during which no adhesiolysis involving the stomach or gastropexy site was required. No colostomy revision, fixation of the colostomy limb, or closure of the lateral defect was performed because staged colostomy closure was planned. Colostomy closure was subsequently recommended, but the patient declined additional surgery. No recurrence was observed during 24 months of follow-up.

CONCLUSIONS: Internal hernia involving the stomach after sigmoid colostomy is extremely rare, and its optimal management remains unclear. Laparoscopic anterior gastropexy with a technical modification using the round ligament may be a feasible and minimally invasive option in selected patients, potentially maintaining physiological gastroduodenal alignment and avoiding excessive angulation of the gastric outlet.