title: Rare complication after totally extraperitoneal endoscopic inguinal hernia repair: Small bowel perforation without peritoneal disruption.
abstract: We report a rare case of visceral injury after totally extraperitoneal endoscopic inguinal hernia repair. A 48-year-old man underwent needlescopic totally extraperitoneal repair of a direct inguinal hernia. Bleeding from a branch of the inferior epigastric vessels occurred at the beginning of the extraperitoneal dissection with a monopolar electrosurgical device. Hemostasis was prolonged. However, herniorrhaphy and mesh repair were successfully performed, and no peritoneal disruption or pneumoperitoneum was visible. The patient was discharged home on the next day. However, 30 h after this operation, he underwent diagnostic and operative laparoscopy because of acute abdominal pain. Ileal perforation was found and repaired, and pathological examination indicated cautery artifact. Thus, thermal damage to the ileum during the initial operation may have caused the bowel perforation. To the best of our knowledge, no other cases of bowel perforation after totally extraperitoneal repair without peritoneal disruption have been reported.
authors.affiliation: Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan. shigehiro.kojima@shmc.jp.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Kojima
authors.affiliation: Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan.
authors.forename: Tsuguo
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Honda
authors.affiliation: Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Nishiguchi
authors.affiliation: Department of Pathology, Sainokuni Higashiomiya Medical Center, Saitama, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Ogawa
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged
keywords: Monopolar electrosurgery; TEP; thermal injury