A Case of Port-site Hernia Occurring between Muscles after Fascia Closure

Abstract

An 87-year-old woman underwent laparoscopic high anterior resection and D2 dissection for sigmoid colon cancer with liver metastasis. On the night of postoperative Day 6, she developed abdominal pain and vomiting, but she was given analgesics and kept under observation. The following morning, a tender mass centered in the right lower abdomen was evident, a port-site incarcerated hernia was diagnosed by abdominal computed tomography, and emergency surgery was performed. The umbilical wound was extended caudad, and intraperitoneal observations showed that the small intestine was stuck deep inside the 12-mm port site. When the port wound was cut open, the aponeurosis of the external oblique muscle had been sutured closed, and the incarcerated small intestine was seen beneath the fascia. There was a hernia cavity between the internal and external oblique muscles, and this extended to under the right hypochondrium. Since intestinal necrosis was suspected, the strangulated small intestine was partially resected, the peritoneum/transverse abdominal muscle and the aponeurosis of the external oblique muscle were individually closed, and a drain was placed in the hernia cavity to end the procedure. Many cases of port-site hernia have been reported in recent years with the general adoption of laparoscopic surgery, but there have been few reports of intermuscular prolapse after fascial closure. A port-site hernia can occur even if the fascia has been closed, and this indicates the importance of full-thickness suture closure of the abdominal wall, including the peritoneum.