A Case of Strangulated Small Bowel Obstruction Probably Caused by a Slipped-down Staple After Laparoscopic Sigmoidectomy

Abstract

A 44-year-old woman who had undergone sigmoidectomy 42 months earlier for rectosigmoid cancer presented to our hospital with acute abdominal pain. The anal side of the tumor had been cut with an automatic suture equipment, and anastomosis had been performed by the double stapling technique. Abdominal CT showed a closed loop of small intestine and a positive whirl sign. Based on the findings, the patient was diagnosed as having strangulated small bowel obstruction and emergent open laparotomy was performed via a midline abdominal incision. We elevated the small intestine from the pelvic cavity manually, and the strangulation was released. Examination confirmed the formation of a band containing a staple on the oral side of the small intestine, with ischemic change and scar formation on the mesentery on the anal side. We suspected that the strangulation was caused by a band with the slipped-down staple. Bowel resection was not needed. The patient was discharged 6 days after the operation. We think it is important to take measures to prevent staples from an automatic suture equipment from slipping down during the operation.