title: Staple line as a cause of unusual early internal hernia after appendectomy.
abstract: The use of mechanical stapling devices in laparoscopic appendectomies has become a common practice. Occasionally, the retained staples have been described to cause adhesions that might result in bowel obstruction. Early bowel obstruction after routine abdominal surgery should be closely investigated and might warrant early re-exploration. We present a rare case of small bowel obstruction caused by a staple line adhesive band one week after appendectomy. A 46-year-old female underwent laparoscopic appendectomy for uncomplicated appendicitis. A linear endoscopic stapling device was utilized during the procedure. The patient was discharged without complication. One week later, the patient presented to the emergency room for abdominal pain and she was discharged after adequate pain control. Several hours later she returned with similar symptoms, and she was diagnosed with distal small bowel obstruction by computed tomography scan. During the diagnostic laparoscopy there was an internal hernia through a defect created by the appendiceal staple line and the adjacent small bowel mesentery. After reduction of the hernia, the small bowel venous drainage improved, and no intestinal resection was necessary. The offending staple was removed and the staple line covered with omentum. The patient had complete resolution of symptoms and she was discharged the following day. No perioperative complications occurred. Mechanical staplers are routinely used in laparoscopic appendectomy. The staple line should be inspected at the end of the procedure to confirm the absence of free, unformed staples that can generate adhesions and postoperative complications.
authors.affiliation: Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Electronic address: RAJANM@ccf.org.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Rajan
authors.affiliation: Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Electronic address: fernandodip@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Dip
authors.affiliation: Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Electronic address: Szomsts@ccf.org.
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.affiliation: General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy. Electronic address: amzanghi@unict.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Zanghì
authors.affiliation: General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy. Electronic address: andreacavallaro@tiscali.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cavallaro
authors.affiliation: General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy. Electronic address: divitama@unict.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Di Vita
authors.affiliation: General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy. Electronic address: f.cardi@unict.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardì
authors.affiliation: General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy. Electronic address: dimattiapaolo@libero.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Mattia
authors.affiliation: General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy. Electronic address: alecap@unict.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappellani
authors.affiliation: Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Electronic address: elomenzo@hotmail.com.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Menzo
authors.affiliation: Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Electronic address: rosentr@ccf.org.
authors.forename: Raul
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D001062:Appendectomy / Q000295:instrumentation* / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology*; D007421:Intestine, Small; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D013537:Sutures / Q000009:adverse effects*
keywords: Laparoscopic appendectomy; Stapler complications