Adhesional small bowel obstruction related to stapling device from previous laparoscopic inguinal hernia repair

Abstract

Small bowel obstruction (SBO) is common surgical presenting problem, accounting for roughly 15 000 laparotomies per year in the UK. However, SBO post laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is uncommon with an estimated incidence of 0.2%-0.5%. The common causes for SBO post-TAPP include inadequate closure, port-site herniation and adhesions. Here, we present a case of adhesional SBO related to stapling device from previous laparoscopic inguinal hernia repair and review alternative methods for mesh fixation. This case reports a rare but life-threatening complication from a commonly performed day case procedure and highlights importance of adequate surgical technique when inserting foreign bodies intra-abdominally. The patient required an emergency laparotomy and small bowel resection, developed postoperative ileus which managed with a nasogastric tube, intravenous fluids and parenteral nutrition and was discharged 12 days postoperatively.

Keywords: gastrointestinal surgery; general surgery; surgery.

Figure 1

CT: Preoperative CT abdomen and pelvis with intravenous contrast. (A) Volume reformat showing distribution of normally positioned tack staples (arrowhead) and the displaced tack (arrow). (B) Coronal reformat showing the displaced tack (arrow) and the resultant dilated small bowel loops with congested mesentery (asterisk). (C) Axial slice at the level of the displaced tack (arrow). (D) Axial slice through the obstructed small bowel.

Figure 2

Intraoperative photography: misplaced laparoscopic tack from previous laparoscopic transabdominal preperitoneal inguinal hernia repair causing a band adhesion.

Figure 3

Intraoperative photography: Meckel’s diverticulum under the band adhesion.

Figure 4

Intraoperative photography: congested small bowel and oedematous bruised mesentery after band release.