Internal hernia and small bowel obstruction caused by a linear cutter staple at appendiceal stump following laparoscopic appendectomy
A 22-year-old female presented to the emergency room with a 24-h history of periumbilical pain, associated with nausea, vomiting and a low-grade fever. On examination, she was afebrile but focally tender in the right lower quadrant over McBurney's point. A computed tomography (CT) scan showed a dilated appendix with fat stranding. She was taken to the operating room for laparoscopic appendectomy. Three trocars were used. The mesoappendix was divided with the harmonic scalpel, and the base of the appendix was divided with an EndoGIA stapler (Ethicon Endosurgery, Cincinnati, OH, USA). The postoperative course was uncomplicated and the patient was discharged the next day.\nSix days later, the patient returned to the emergency room with abdominal pain for <12 h in the periumbilical region. The pain was worse than when she had appendicitis. She reported chills, nausea and vomiting. On examination, she was tender in the periumbilical region and mildly distended. She underwent CT scan, which showed a small bowel obstruction with a transition point in the right lower quadrant (Fig. ). She was taken to the operating room for an exploratory laparoscopy. A staple attached to the appendiceal stump on one end had snagged a loop of small bowel and small bowel mesentery with the other end (Fig. ). It was causing an internal hernia and contained a small bowel loop. The staple was freed and removed laparoscopically with no full thickness defect of the small bowel. The staple line was imbricated with intracorporeal Lembert sutures. The patient did well and was discharged the following evening.