195 Small bowel obstruction through peritoneal defect herniation after a totally extraperitoneal hernia repair- A unusual complication case seriesSanthosh Loganathan, Stephen Chapman, Laura Whittaker, Chris Newman
The rates of major complications associated with totally extraperitoneal (TEP) inguinal hernia repair are reportedly low, and intra-abdominal complications are rare. However, here we present a case series with small bowel obstruction through herniation of the small bowel into the peritoneal defect after a TEP, which is a rare complication.
The first case, a 71year old male two weeks post-TEP left inguinal hernia repair, presented with abdomen pain, vomiting, distension, and bowels not opened for three days with elevated inflammatory markers. Computed Tomography of the abdomen and pelvis (CTAP) demonstrated small bowel obstruction secondary to a loop of inflamed small bowel adherent to the anterior abdominal wall in the left inguinal region. During emergency diagnostic laparoscopy found to have a small bowel loop passing through a peritoneal defect just lateral to the medial umbilical ligament, converted to laparotomy, and small bowel resection was performed. In the second case, a 61-year-old male presented with similar complaints and elevated inflammatory markers two days post bilateral TEP. The CTAP showed dilated small bowel with a transition point in the left iliac fossa. Emergency diagnostic laparoscopy found a peritoneal defect on the left groin with small bowel herniation. The bowel-reduced back and the defect was closed with sutures.
Small bowel obstruction due to a peritoneal defect after TEP is a rare but potentially fatal complication. Therefore, the clinician should have a low threshold for surgery, as it is unlikely to resolve with conservative treatment like the adhesional bowel obstruction.