Published: 2022-03-28

Internal hernia and caecal volvulus secondary to adhesion at inguinal preperitoneal mesh

Daniel Tani, Goutham Sivasuthan, Reuben Ndegwa, Omar Mansour


We reported the case of a caecal volvulus in a 52-year-old female which appeared to result from a dense intra-abdominal adhesion from a previous inguinal hernia repair. The patient presented with upper abdominal pain and obstructive symptoms. Computed tomography revealed the caecum in a whirlpool appearance characteristic of a volvulus, and there was resulting proximal bowel dilatation suggesting obstruction. The patient had previously undergone a laparoscopic right inguinal hernia repair 9 years prior to presentation in addition to a hernia repair on the contralateral side, and a left sided Spigelian hernia repair. She was managed operatively with exploratory laparoscopy. Her right iliac fossa had scarring at the peritoneum consistent with an inguinal hernia mesh with no intra-abdominal breach. There was a band adhesion originating from this region, directly posterior to the scarring, with the caecum wrapping around the adhesion and causing an obstruction. The internal hernia was reduced, a right hemicolectomy performed, and the patient successfully discharged after six days. Adhesion formation following inguinal hernia repairs are not a well-documented complication. In this case, there was an obvious adhesion that acted as the fulcrum for a caecal volvulus and clearly originated on the abdominal wall directly behind the previous inguinal hernia mesh suggesting that the hernia repair may have instigated the adhesion. Whilst rare, adhesion formation may need to be a consideration in inguinal hernia mesh repairs.


Internal hernia, Inguinal hernia, Mesh, Volvulus, Obstruction

Full Text:



Liem MS, Graaf Y, Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, et al. Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair. N Engl J Med. 1997;336(22):1541-7.

Vrijland WW, Tol MP, Luijendijk RW, Hop WC, Busschbach JJ, Lange DC, et al. Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg. 2002;89(3):293-7.

Kingsley D, Vogt DM, Nelson MT, Curet MJ, Pitcher DE. Laparoscopic intraperitoneal onlay inguinal herniorrhaphy. Am J Surg. 1998;176(6):548-53.

Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg. 2012;397(2):271-82.

Langbach O, Holmedal SH, Grandal OJ, R√łkke O. Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain. Gastroenterol Res Pract. 2016;2016:2631598.

Silva ANS, Kouroumpas E, Fearnhead N, Morton JR. Adhesional small bowel obstruction related to stapling device from previous laparoscopic inguinal hernia repair. BMJ Case Rep. 2019;12(4):229377.

Vader VL, Vogt DM, Zucker KA, Thilstead JP, Curet MJ. Adhesion formation in laparoscopic inguinal hernia repair. Surg Endosc. 1997;11(8):825-9.

Garrard CL, Clements RH, Nanney L, Davidson JM, Richards WO. Adhesion formation is reduced after laparoscopic surgery. Surg Endosc. 1999;13(1):10-3.

Farmer L, Ayoub M, Warejcka D, Southerland S, Freeman A, Solis M. Adhesion formation after intraperitoneal and extraperitoneal implantation of polypropylene mesh. Am Surg. 1998;64(2):144-6.