Abstract
BackgroundObesity is a risk factor for the development of endometrial cancer and abdominal wall hernias. We report a case of tension pneumoperitoneum that developed after gynecological surgery and mesh repair of a ventral hernia.Case presentationA 57-year-old Asian Taiwanese woman with a body mass index of 52.9 (kg/m2) underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy due to endometrial cancer, and ventral herniorrhaphy with mesh due to ventral hernia. Tension pneumoperitoneum with severe dyspnea developed on postoperative day 14. Rather than performing emergency laparotomy as in visceral perforation, a transabdominal catheter was inserted to drain the intra-abdominal gas. This approach dramatically relieved the tension pneumoperitoneum and dyspnea. Our patient then recovered smoothly; the catheter was removed on postoperative 24, and she was discharged on postoperative day 28. The clinical course of the endometrial cancer and repaired ventral hernia was well at the 1-year follow-up.ConclusionsTension pneumoperitoneum, which may result from the valve effect of unhealed abdominal mesh, could develop after gynecological surgery and hernia mesh repair in obese patients. Under these conditions, emergency drainage of the intra-abdominal gas by catheter insertion is sufficient to relieve the abdominal pressure and correct the conditions, while emergency laparotomy as in visceral perforation is unnecessary and may increase patient morbidities.
Highlights
ConclusionsTension pneumoperitoneum, which may result from the valve effect of unhealed abdominal mesh, could develop after gynecological surgery and hernia mesh repair in obese patients
Obesity is a risk factor for the development of endometrial cancer and abdominal wall hernias
Unlike the tension pneumoperitoneum (TP) caused by gastrointestinal perforation which needs emergency laparotomy to repair the perforation, it was unnecessary for our patient
Summary
Most surgery-related cases of pneumoperitoneum resolve spontaneously within 2 weeks after surgery. Caution should be taken if the pneumoperitoneum occurs or progresses 2 weeks after surgery in an obese patient with a mesh-repaired hernia. Abdominal distention, and hemodynamic change, the possibility of TP should be considered, and emergency drainage of the intra-abdominal gas is needed. Emergency laparotomy is unnecessary for this condition
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