Management of intestinal obstruction following laparoscopic donor nephrectomy
A 47-year-old lady presented with a history of vomiting and constipation for the past 5 days. This was 8 days after she underwent a laparoscopic donor nephrectomy. Upper gastrointestinal (GI) endoscopy revealed large amount of bile stained fluid in the stomach. A CECT suggested dilatation of the stomach, duodenum and proximal jejunum with features of bowel obstruction in the mid jejunum, with the loops lying in left renal fossa []. A provisional diagnosis of obstructed left para duodenal hernia was made. Patient was explored laparoscopically, through the same port sites that were made earlier for the nephrectomy (two 10 mm ports, one at the level of umbilicus on the left side lateral to rectus muscle and another in the midclavicular line just above the left anterior superior iliac spine; two 5-mm ports, one subcostal in the midclavicular line and another in the anterior axillary line in the lumbar region). Herniation of small bowel was noted in the left paraduodenal space []. The herniation had occurred through a defect in the transverse mesocolon which probably would have occurred during the donor nephrectomy procedure. The loop of bowel was densely adhered to the tail of the pancreas and had to be dissected of it and reduced []. The integrity of the bowel was intact. The defect in the mesocolon was sutured []. Patient had an uneventful recovery and was discharged from hospital on the 5th postoperative day.