Abstract
Delayed intestinal stenosis after bowel-preserving reductions of incarcerated hernias have rarely been reported. Two patients who developed delayed bowel obstruction after bowel preservation during surgery for incarcerated femoral hernias are reported. Laparoscopic surgery was performed, and ischemic small bowel stenosis was diagnosed in both cases.
In one patient after preservation of small bowel without any changes in color of the serosa, stenosis still developed later. In the other patient with linear color changes of the small bowel serosa, indocyanine green (ICG) fluorescence angiography showed enhancement of almost the entire bowel wall, but some areas of poor linear enhancement corresponding to the serosal changes were noted. Although bowel preservation was still considered safe, cicatricial changes causing stenosis later occurred in the areas of poor enhancement.
The possibility of delayed ischemic small bowel stenosis after surgery for incarcerated hernias should always be kept in mind. Patients with even only slightly poor enhancement on ICG fluorescence angiography require careful follow-up, and surgery must be considered if any symptoms of intestinal obstruction develop.
