Incarcerated Richter's hernia after laparoscopy: a case report

Abstract

An unusual case of Richter's hernia on the 5th day after laparoscopy is presented. The complaints simulated a postoperative hematoma, but they became so intense that the expansion was surgically explored: a conservative procedure on the loop of small bowel was possible. To prevent this complication after laparoscopy careful shaking of the abdominal wall at removal of the instruments is necessary.

PIP: A rare case of Richter's hernia after laparoscopy, the 2nd such hernia reported among a total of 4 cases of small bowel hernia, is presented. This patient was a 32-year old woman who had Hulka clip sterilization without any difficulties, using a 10 mm trocar and a Wolff laparoscope, with 3 liter carbon dioxide for induction of pneumoperitoneum. Her symptoms were only severe pain and vomiting starting on the 5th postoperative day, and a hematoma-like swelling. Since her pain was so intense, the area was explored under general anesthesia the same day. A plum-sized, strangulated loop of the jejunum was apparent, with serous fluid but no blood, incarcerated between the skin and the abdominal muscles. A small serosal laceration in the bowel was corrected with 2 interrupted Dexon sutures. Symptoms of hernia have occurred 3-15 days after laparoscopy in previously reported cases. It is fortunate that this patient was not treated as though she had a hematoma, since serious perforation of the bowel and peritonitis would have resulted. It is important to insure that all gas has flowed out of the abdomen before removing the laparoscope or the trocar sheath, and advisable to shake the abdomen wall carefully while removing the instruments, to prevent this complication.