title: Forceful evacuation of retained pneumoperitoneum mimics an acute recurrent inguinal hernia.
abstract: BACKGROUND
  Laparoscopic exploration of the contralateral side during inguinal herniorrhaphy in infants is becoming popular. We present an unusual complication of this technique, namely forceful evacuation of retained pneumoperitoneum mimicking an acute recurrent hernia.
  
  
  METHODS
  A 9-month-old female presented for right inguinal herniorrhaphy. Laparoscopic exploration of the left side revealed a closed left internal ring. The pneumoperitoneum was evacuated. The hernia sac had started to tear so it was closed with a running horizontal mattress suture instead of a double ligature after twisting. The internal ring was closed. Upon emergence from anesthesia, the right groin was filled with a mass that we felt was subcutaneous emphysema from evacuation of residual pneumoperitoneum. But to rule out an acute recurrent hernia, we re-explored the groin. There was a large collection of air that had dissected in the subcutaneous tissues and under Scarpa's fascia. The hernia repair was intact. Follow-up 6 months after the repair showed no evidence of a recurrence.
  
  
  RESULTS
  This is the first report of an unusual complication of laparoscopic exploration of the contralateral side during hernia repair. Two factors contributed to it. The sac closure was a running mattress suture, which is not as airtight as a double ligature after twisting. The second is the incomplete evacuation of the pneumoperitoneum.
  
  
  CONCLUSIONS
  With the increasing use of laparoscopic contralateral exploration, this case illustrates the need to evacuate the pneumoperitoneum as thoroughly as possible and to consider an airtight closure of the sac.
authors.affiliation: Division of Pediatric Surgery, Georgetown University School of Medicine and Children's National Medical Center, Washington, DC 20007, USA.
authors.forename: Louis C
authors.initials: LC
authors.lastname: Benjamin
authors.forename: A Alfred
authors.initials: AA
authors.lastname: Chahine
mesh_terms: D000208:Acute Disease; D003951:Diagnostic Errors; D005260:Female; D006552:Hernia, Inguinal / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D012008:Recurrence; D013352:Subcutaneous Emphysema / Q000175:diagnosis* / Q000209:etiology