Incarcerated trocar site herniation of the small bowel following laparoscopic myomectomy - a case report

Abstract

Introduction: Laparoscopic surgery has become one of the greatest achievements of modern surgery. It is routinely used in the treatment of diseases in the abdominal cavity, retroperitoneum, thorax, etc. Minimally invasive surgery has led to a drastic reduction in post-operative hernias, which are typical­ly a concomitant complication of open surgery. According to Essentials of General Surgery, the inci­dence of postoperative hernia is lower than in conventional surgery, 0.021 - 6%. Materials and Methods: A 51-year-old female patient was admitted to the Second Department of Sur­gery complaining of a two-day lower abdominal discomfort, followed by multiple episodes of nausea and vomiting a clinical presentation of ileus. The previous week she was operated laparoscopically for myoma and a myomectomy was performed. Physical examination revealed a palpable mass at the left side of the abdominal wall. The radiological findings showed small bowel loops herniated through the abdominal wall in the paraumbilical region, with dilated proximal small bowel segments, due to in­carcerated incisional hernia. Laparotomy established an incarcerated incisional hernia with a stran­gulated small bowel in the place of the left 5mm trocar. Results: Resection of the strangulated segment was performed, the gastrointestinal tract was restored via latero-lateral anastomosis, and a small quantity of clear liquid was drained and sent for microbi­ology tests. Two weeks later, after a non-complicated postoperative period, the patient was discharged from the hospital in a generally good health. Conclusion: Although rare, trocar-site herniation is a possible complication of any laparoscopic pro­cedure, which should be kept in mind. The early diagnosis and management are important to avoid further patient morbidity.