Diagnosis of a Case of Colonic Perforation Caused by a Kugel Patch Using Fiberoptic Endoscopy

Abstract

A 38-year-old male was urgently admitted to our department with an incarcerated left inguinal hernia. Reduction was unsuccessful, and emergency surgery was performed the day after admission. The surgery was performed laparoscopically, but because it was difficult to manage the incarcerated omentum, we converted to an inguinal incisional approach. About two years later, the patient had a positive fecal occult blood test, and fiberoptic colonic endoscopy was performed at our hospital. The endoscopy showed a structure that seemed to be part of a Kugel patch in the sigmoid colon. There were no subjective symptoms or abnormal blood tests. However, we assumed that changes due to chronic inflammation would probably cause problems later. Therefore, we performed curative surgery with laparoscopic assistance. Initial laparoscopic observation confirmed adhesions between the left inguinal bed and sigmoid colon. We peeled away the adhesions at the top and bottom of the patch, and then performed open sigmoidectomy, including peeling of the prosthesis from the inguinal bed. We then reconstructed the digestive tract using end-to-end anastomosis. Despite our concerns, no infections occurred in the wound or inguinal bed, and the patient was discharged 12 days after the operation. More than 1 year has passed since the surgery without problems. As only a few cases of gastrointestinal perforation caused by a Kugel Patch have been reported, this appears to be an extremely rare case. Surgical management should take into consideration the possibility of serious complications, regardless of the type of procedure or prosthesis.