Case Report
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World J Gastrointest Endosc. Nov 16, 2014; 6(11): 568-570
Published online Nov 16, 2014. doi: 10.4253/wjge.v6.i11.568
Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia
Fatih Sumer, Cuneyt Kayaalp, Mehmet Ali Yagci, Emrah Otan, Huseyin Kocaaslan
Fatih Sumer, Cuneyt Kayaalp, Mehmet Ali Yagci, Emrah Otan, Huseyin Kocaaslan, Department of Surgery, Inonu University, Malatya 44315, Turkey
Author contributions: Sumer F contributed to surgeon of the case, planning, collecting the data and writing; Kayaalp C wrote the paper; Yagci MA contributed to the planning and critical editing; Otan E contributed to the language translation and critical editing; Kocaaslan H contributed to the surgeon of the case and collecting the data
Correspondence to: Cuneyt Kayaalp, MD, Professor, Department of Surgery, Turgut Ozal Medical Center, Inonu University, Elazig Yolu 10. Km., Malatya 44315, Turkey. cuneytkayaalp@hotmail.com
Telephone: +90-422-3410660 Fax: +90-422-3410229
Received: May 5, 2014
Revised: September 17, 2014
Accepted: October 1, 2014
Published online: November 16, 2014
Abstract

This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period.

Keywords: Laparoscopic cholecystectomy, Trocar site hernia, Endoscopic retrograde cholangiopancreatography, Postoperative complications

Core tip: This report demonstrates that negligence of trocar site closure after laparoscopic surgery can result in very early trocar site herniation. This may occur particularly if an endoscopic intervention is required in the early postoperative period. Suturing the trocar site is not only important for the late trocar site herniations, it is imperative for early hernia problems as well.