Special type trocar-site hernia with evisceration of the appendix following laparoscopic repair of a perforated duodenal ulcer

Abstract

Trocar-site hernia is an uncommon complication of laparoscopic surgery and can be classified as early-onset, late-onset or special type. Special type hernias usually occur in the early postoperative period and result in evisceration of intra-abdominal contents through all layers of the abdominal wall without an overlying hernia sac. We present a case of special type herniation of the appendix through a 5-mm trocar site in the right iliac fossa following laparoscopic repair of a perforated duodenal ulcer. In this case, herniation occurred after removal of a drain inserted through the trocar site intraoperatively and was treated with emergent open appendicectomy. A number of patient and technical factors may be associated with an increased risk of trocar-site herniation including increasing age, elevated body mass index, increasing trocar size, longer procedure duration and absence of fascial closure. These factors must be borne in mind when planning trocar placement and number to reduce the risk of herniation.

Appendicitis in a drain-site hernia

“…The herniation of an otherwise normal vermiform appendix in to a drain site has previously been described sporadically in several case reports [5][6][7], including two cases of evisceration of the appendix [8,9]. While appendicitis has previously been documented in port-site hernia [4,10], we describe what we believe to be the first reported case of acute appendicitis in a drain-site hernia.…”

Evisceration of a Small Bowel Segment Through a Drain Site: Lesson Learnt

“…Patients' obesity and nutritional status, chronic use of corticosteroids, and frailty of elderly patients seem to contribute to such a complication. Moreover, the irregular shape of the draining tract, midline location of the drain site, long duration of surgery, peritonitis, increased intra-abdominal pressure, and the use of large diameter drain -tubes or flat drains, are also reported as risk factors [1,[9][10][11][12][13]. This article reports a case of the evisceration of a small bowel segment through a corrugated drain site six hours after the patient underwent a subtotal cholecystectomy for gangrenous ischemic cholecystitis.…”