Abstract
A woman in her 80s visited our hospital with severe abdominal pain and hematemesis. An emergent gastrofiberscopy was performed, and she was diagnosed with gastroesophageal reflux. However, she continued to have severe abdominal pain, rebound tenderness and muscular defense. An abdominal CT scan was performed and indicated strangulated bowel obstruction. Because of hypovolemic shock and acute renal failure, conservative therapy with fluid replacement and insertion of a long decompression tube was initiated. On the third day of hospitalization, the patientʼs general condition improved and an operation was performed. The operative findings were massive hemorrhagic ascites and intestinal necrosis. The Kugel patch had adhered to the omentum, trapping the small intestine into an adhesive band around the prosthesis. This Kugel patch had been inserted 5 years previously. Recently, several complications involving prostheses have been reported, including infection, ileus and perforation, but there have been few cases of strangulated bowel obstruction caused by adhesion of a direct Kugel patch. Therefore, we chose to report this case along with a review of the literature.
