Trocar site hernia after laparoscopy: Early recognition prevents catastrophic sequelae

  • Caroline S. Kwon
    Reprint Address: Caroline S. Kwon, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
    Search for articles by this author
  • Athmika Vaseeharan
    Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
    Search for articles by this author
  • Mark V. Sauer
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
    Search for articles by this author
Published:September 20, 2022DOI:



      Trocar site hernia is a rare but potentially serious complication of laparoscopic surgery that may lead to bowel incarceration and strangulation. Prompt diagnosis by emergency physicians facilitates timely intervention that prevents bowel necrosis. We report a case of trocar site hernia presenting to the emergency department (ED) with abdominal pain that was correctly diagnosed and promptly managed.

      Case Report

      A 25-year-old woman, gravida 2, abortion 2, underwent outpatient surgery and laparoscopic removal of a ruptured right-sided tubal pregnancy without any intraoperative difficulties. However, 48 h later, she presented to the ED complaining of acute abdominal pain and nausea. Computed tomography revealed a loop of small bowel herniating through a 12-mm right lower quadrant trocar site defect in the fascia. She was taken back to the operating room, where the computed tomography findings were confirmed and the entrapped bowel was successfully reduced and the fascial defect repaired. The patient was discharged home feeling much improved.

      Why Should an Emergency Physician Be Aware of This?

      Trocar site hernia is a rare but potentially dangerous complication that can present with acute symptoms or be asymptomatic if late in onset. Intestinal necrosis begins as soon as 6 h after constriction of blood flow to entrapped bowel, so timely intervention is critically important. Therefore, trocar site hernias should be considered in patients presenting with abdominal complaints after laparoscopic surgery and included in the differential diagnosis of bowel obstruction.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Swank HA
        • Mulder IM
        • la Chapelle CF
        • Reitsma JB
        • Lange JF
        • Bemelman A.
        Systematic review of trocar-site hernia.
        Br J Surg. 2012; 99 (Available at) (Accessed Xxxx XX2022): 315-323
        • Tonouchi H
        • Ohmori Y
        • Kobayashi M
        • Kusunoki M.
        Trocar site hernia.
        Arch Surg. 2004; 139 (Available atAccessed Xxxx XX, 2022): 1248-1256
        • Cottam DR
        • Gorecki PJ
        • Curvelo M
        • Weltman D
        • Angus LD
        • Shaftan G.
        Preperitoneal herniation into a laparoscopic port site without a fascial defect.
        Obes Surg. 2002; 12: 121-123
        • Uslu HY
        • Erkek AB
        • Cakmak A
        • et al.
        Trocar site hernia after laparoscopic cholecystectomy.
        J Laparoendosc Adv Surg Tech A. 2007; 17: 600-603
        • Nassar AH
        • Ashkar KA
        • Rashed AA
        • Abdulmoneum MG.
        Laparoscopic cholecystectomy and the umbilicus.
        Br J Surg. 1997; 84: 630-633
        • Kadar N
        • Reich H
        • Liu CY
        • Manko GF
        • Gimpelson R.
        Incisional hernias after major laparoscopic gynecologic procedures.
        Am J Obstet Gynecol. 1993; 168: 1493-1495
        • Reardon PR
        • Preciado A
        • Scarborough T
        • Matthews B
        • Marti JL.
        Hernia at 5-mm laparoscopic port site presenting as early postoperative small bowel obstruction.
        J Laparoendosc Adv Surg Tech A. 1999; 9: 523-525
        • Senadheera DI
        • Jayasundara DMCS
        • Jayawardane IA.
        Trocar-site herniation (TSH) of the small bowel following laparoscopy despite rectus sheath closure, resulting in subacute bowel obstruction in the early post-operative period: a case discussion and review of literature.
        Obstet Gynecol Cases Rev. 2020; 7 (Available atAccessed 3.1.2022): 186
        • Bailey CR
        • Leeper WR
        • Johnson PT
        • Berlanstein BP
        • Fishman EK
        • Coquia SF.
        Richter's hernia through the broad ligament: role of computed tomography and ultrasonography in facilitating diagnosis and rapid operative repair.
        Surgery. 2016; 159: 975-977
        • Jang TB
        • Schindler D
        • Kaji AH.
        Bedside ultrasonography for the detection of small bowel obstruction in the emergency department.
        Emerg Med J. 2011; 28: 676-678
        • Argintaru N
        • Al-Den A
        • Chenkin J.
        Diagnosis of a strangulated laparoscopic incisional hernia with point-of-care ultrasonography.
        West J Emerg Med. 2015; 16 (Available atAccessed Xxxx XX2022): 450-452
        • Siadecki SD
        • Frasure SE
        • Saul T
        • Lewiss RE.
        Diagnosis and reduction of a hernia by bedside ultrasound: a case report.
        J Emerg Med. 2014; 47: 169-171
        • Blaivas M.
        Ultrasound-guided reduction of a Spigelian hernia in a difficult case: an unusual use of bedside emergency ultrasonography.
        Am J Emerg Med. 2002; 20: 59-61
        • Boughey JC
        • Nottingham JM
        • Walls AC.
        Richter's hernia in the laparoscopic era: four case reports and review of the literature.
        Surg Laparosc Endosc Percutan Tech. 2003; 13: 55-58