Successful Laparoscopic Management of Pericaecal Hernia Causing Small Bowel Obstruction

Abstract

Hans Mare* and William Edward Tjhin

Background: Small bowel obstruction as a surgical condition can vary greatly in its management. While most cases can be successfully treated conservatively, a not- insignificant number of patients require surgical intervention, particularly those with internal hernias as the cause of their obstruction. Due to the nature of small bowel obstructions often leading to significant abdominal distension, laparoscopic intervention has been avoided to reduce the risk of perforating loops of bowel on entry, with laparotomy being the favoured procedure as a result.

Case presentation: A 54-year-old woman presented with symptoms and signs suggestive of a small bowel obstruction. She had a computed tomography scan that effectively confirmed a closed loop small bowel obstruction in her right lower quadrant. Her abdominal distension improved following nasogastric decompression and was therefore deemed suitable for a diagnostic laparoscopy rather than laparotomy. On entry a pericaecal hernia was noted and extensive adhesiolysis performed to successfully reduce the small bowel contained within. No bowel resection was performed, and the patient was discharged home on day 3 following her procedure.

Conclusion: Laparoscopic surgery is a viable alternative to laparotomy in patients who require operative intervention for acute small bowel obstruction secondary to internal hernia without significant abdominal distension.