Parietal peritoneal hernia after abdominal hysterectomy for forty years: A case report.

Background: Internal hernia is a rare complication following abdominal surgery, primarily resulting from structural defects caused by anastomosis. We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insufficient peritoneal closure.

Case summary: A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy. Abdominal computed tomography revealed a suspicious closed loop of intestine; then, a laparotomy was performed for suspected internal hernia. During the procedure, herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified. Intestinal reduction, resection of the ischemic segment and closure of the peritoneal defect were performed. The patient recovered well.

Conclusion: Non-closure of peritoneum might lead to late internal hernias. Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.