Prolonged Ileus Due to Underlying Shigella Infection After Bilateral Open Inguinal Hernia Repair

Abstract

We present a rare case of prolonged ileus caused by underlying Shigella infection after surgical hernia repair. Infectious disease is an uncommon cause of postoperative prolonged ileus in adults. Our 48-year-old male patient underwent bilateral open inguinal hernia repair and open umbilical hernia repair without complication at an academic institution, with same-day discharge. Eight days later, he presented to the emergency department with complaints of severe cramping abdominal pain, nausea, emesis, and watery diarrhea. Physical examination, computed tomography scan of the abdomen and pelvis, and abdominal X-ray were initially concerning for bowel obstruction. The patient was admitted to the general surgery service. Concern for ileus with underlying gastritis arose after a small bowel follow-through showed contrast eventually reaching the rectum. A subsequent gastrointestinal pathogens panel was positive for Shigella. The patient's symptoms resolved after appropriate antibiotic treatment. Shigellosis and other infectious diseases should be considered in the differential diagnosis of postoperative prolonged ileus.

Keywords: general surgery complication; ileus; infectious disease; inguinal hernia repair; shigella; umbilical hernia repair.

Figure 1. Computerized tomography of the abdomen and pelvis with intravenous contrast, coronal view.

The image depicts distended loops of the proximal small bowel with a probable transition point in the right hemiabdomen-right lower quadrant.

Figure 2. X-ray of the abdomen.

The image depicts diffuse elevated loops of the small bowel with a nasogastric tube (NGT) in place.