A Case of Preperitoneal Herniation of the Small Bowel Causing Intestinal Obstruction Following a Totally Extra Peritoneal Hernia Repair

Abstract

Preperitoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. A 57-yearold male underwent a right inguinal hernia totally extra peritoneal repair on 20/10/2021. Initial recovery was uncomplicated but on post operative day 10, he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction with a possible transition point. An internal hernia was suspected and he was offered urgent diagnostic laparoscopy following counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. A small bowel runthrough did not reveal any pathological abnormalities. A presumptive diagnosis of a preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful postoperative recovery. An inadvertent breach in the peritoneum during a totally extra peritoneal repair can lead to preperitoneal herniation of the small bowel and intestinal obstruction postoperatively.