Very Early Drain Site Hernia with Intestinal Obstruction after Laparoscopic Appendectomy and Debulking of a Mucinous Neoplasm of Appendix: A Case Report

Abstract

Introduction: Trocar site hernia is a rare but potentially life threatening complication of laparoscopic surgery. Among trocar site hernia, drain site herniation is an even rarer complication. Also, due to its low prevalence it is usually diagnosed late and there is a delay in surgical intervention. Herein, we report a case of jejunal loops herniating through a 10 mm drain site in a case of laparoscopic appendicectomy with debulking for mucinous neoplasm of appendix. Case Summary: A 76 year old male known hypertensive, who underwent laparoscopic appendicectomy with debulking for low grade appendiceal mucinous neoplasm presenting on post-operative day 8 with complaints of pain in abdomen, vomiting and inability to pass stool or flatus since 3 days. Patient was hypotensive and was admitted in the ICU for further management. Patient was resuscitated with fluids and intravenous antibiotics and CT abdomen was performed on day 3 of admission as the symptoms were not relieved. CT was suggestive of jejunal loops herniating through the lateral abdominal wall. Patient was taken up for emergency laparotomy and a drain site hernia was diagnosed which was reduced and bowel loops were found to be viable. Herniorrhaphy was done. Patient recovered well and was discharged on post operative day 9. Conclusion: Trocar site hernia is a rare complication that must be kept in mind following laparoscopic surgery. There must be high degree of suspicion to avoid serious complications like necrosis or gangrene of the bowel segment. Also all 10 and 12 mm ports must be closed under vision following laparoscopic surgeries to avoid herniation.