Bowel perforation on recurrent incisional hernia after laparoscopic repair; case report and literature review

Abstract

IntroductionIncisional hernias are located on the site of a previous incision and are due to weakness of the abdominal wall. In years past, the risk of developing an incisional hernia after laparotomy was 25%. This figure has decreased significantly in recent decades thanks to the laparoscopic technique (Hoffman et al., 2021 [1]), but complications occasionally occur.Case presentationWe describe a case of recurrent incisional hernia with bowel perforation in a 58-year-old man who had undergone laparoscopic cholecystectomy 8 years previously and who required repeated laparoscopic procedures. After multiple attempts at closing the hernia, the patient complained of acute abdominal pain located in the right flank. The patient proved to suffer a bowel perforation one month after the surgery.DiscussionDue to the lack of similar cases, it was difficult to prevent the bowel perforation. Moreover, opinions are divided on the treatment of incisional hernia by prosthesis, especially if there is an infectious context. Bowel perforation can be a serious complication of incisional hernia repair. In our case, the delay was suggestive of an idiopathic origin of the condition, which is rare and less described.ConclusionIn the literature, bowel perforation due to laparoscopic adhesiolysis during incisional hernia repair has been described. However, in the current case the complication was most likely directly related to the incisional hernia repair itself.