A Case of Late-onset Small Intestinal Stenosis and Perforation that Occurred after Surgery for Incarcerated Femoral Hernia

Abstract

A 56-year-old woman with no past medical history who visited our hospital with chief complaints of a protrusion in the right groin and abdominal pain. Laparoscopic hernia repair was performed based on a diagnosis of incarcerated right femoral hernia. Because the small intestine was incarcerated in the femoral ring, it was reduced endoscopically. Discoloration was seen in the reduced intestinal tract, but intestinal resection was deemed unnecessary because it improved over time, and mesh repair was performed without any additional procedures. Although ileus thought to be paralytic was seen postoperatively, it improved with conservative treatment, and the patient was discharged on day 10. On postoperative day 27, the patient visited our hospital with sudden, severe abdominal pain. She was in a state of shock, and pneumoperitoneum was observed on abdominal computed tomography (CT). Emergency surgery was performed based on a diagnosis of gastrointestinal perforation. A circumferential, fibrous stenotic site was found in the ileum, and a 1-cm perforation site was detected approximately 30 cm proximal to this site. Intestinal obstruction was thought to have developed due to ischemic stenosis of the small intestine in the incarcerated hernia, causing perforation on the proximal side of the intestinal tract. A few cases of late-onset intestinal stenosis following reduction of incarcerated inguinal hernia have been reported, but cases in which perforation occurred subsequently are extremely rare. The present case is described along with a review of the relevant literature.