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Trocar site hernia after laparoscopy: Early recognition prevents catastrophic sequelae

  • Caroline S. Kwon
    Correspondence
    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
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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  • Athmika Vaseeharan
    Affiliations
    Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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  • Mark V. Sauer
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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Published:September 20, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.09.006

      Abstract

      Background

      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.

      Keywords

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