緊急手術を要した早期型トロッカーサイトヘルニアの3例

抄録

Introduction: Early onset trocar site hernia usually develops within about 2 weeks postoperatively, and patients present with ileus-like symptoms including nausea and vomiting. This condition can require intestinal resection. We report 3 cases of trocar site hernia to find its risk factors, including a 5-mm trocar site hernia case.

Case 1: A 55-year-old woman underwent laparoscopic salpingo-oophorectomy and developed nausea on postoperative day (POD) 16. Computed tomography (CT) showed a 12-mm sized trocar site hernia. Urgent surgery revealed an incarcerated small bowel adhered to the anterior rectus sheath; however, no resection was required.

Case 2: A 45-year-old woman underwent total laparoscopic hysterectomy. She developed nausea, vomiting, and abdominal pain on POD 3. CT showed a 12-mm sized trocar site hernia in the lower abdomen. The small bowel was incarcerated in the fascial defect; however, no adhesions were identified, and the herniated small bowel could be repositioned into the intraperitoneal cavity.

Case 3: A 65-year-old woman underwent total laparoscopic modified radical hysterectomy. A 7-mm drain was inserted through the 5-mm trocar site into the lower abdomen intraoperatively and was removed on POD 3. The patient developed vomiting on POD 5. After fasting and fluid replacement, the vomiting ceased, but recurred on POD 10. CT revealed a trocar site hernia and significant adhesions between the small bowel and the abdominal oblique muscle fascia. A section of the small bowel was perforated during adhesiolysis and required resection.

Conclusion: Obesity, old age, and a multiparous status are patient-related risk factors for trocar site hernia. Surgeon-related factors include imperfect closure of fascia. Appropriate fascial closure is important. Urgent imaging is warranted in patients presenting with ileus-like symptoms to resolve the problem earlier.