Incarcerated Hernia of the Small Intestine through a Peritoneal Tear after Laparoscopic Inguinal Hernia Repair—A Case Report—

Abstract

We present a case of small bowel obstruction secondary to an incarcerated hernia through a peritoneal tear after a laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. A 77-year-old man underwent TAPP repair for bilateral inguinal hernias and developed small bowel obstruction on postoperative day 4. Computed tomography revealed intestinal herniation into the extraperitoneal space at the site of the right TAPP repair. An exploratory laparoscopy was performed and showed that approximately 50 cm of the small bowel had herniated into the preperitoneal and prevesical space through a peritoneal tear in the median edge of the right peritoneal suture performed during the TAPP procedure. The small bowel was reduced, and the peritoneal tear was closed with a suture. TAPP-induced strain/traction on the peritoneal suture line may cause peritoneal tears with a consequent risk of an incarcerated hernia. Thus, careful and firm peritoneal closure is important. Of note, this condition should be considered in the differential diagnoses in patients presenting with such a clinical picture postoperatively.