{"title":"小肠穿孔进入直肠后间隙后，eTEP河停修复切口疝：一个罕见的和危及生命的并发症。","authors":"Toshiro Tanioka, Keisuke Okuno, Masanori Tokunaga, Yusuke Kinugasa","doi":"10.1007/s10029-025-03407-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The enhanced totally extraperitoneal (eTEP) Rives-Stoppa repair is increasingly adopted for incisional hernia repair due to its minimally invasive approachand favorable outcomes. However, rare but severe complications, such as small bowel perforation into the retro-rectus space, may occur, necessitating prompt recognitionand management.</p><p><strong>Case presentation: </strong>An 80-year-old male underwent eTEP Rives-Stoppa repair for an EHS L2 incisional hernia, involving retro-rectus dissection, transversus abdominis release, and mesh placement. On postoperative day 1, he developed hypotension and extensive subcutaneous ecchymosis, without abdominal pain or fever. Initial computed tomography (CT) revealed a retro-rectus fluid collection suggestive of hemorrhage. By day 2, repeat CT showed increased free air and enteric content, indicating bowel perforation. Emergency laparotomy confirmed a dehiscent posterior rectus sheath with a perforated small bowel segment protruding into the retro-rectus space. The mesh was removed, the affected bowel resected, and temporary abdominal closure was performed due to severe inflammation and edema. The postoperative course was complicated by recurrent bacteremia and abscesses, requiring prolonged antimicrobial therapy and intensive care. The patient recovered and was transferred to a rehabilitation facility six months later.</p><p><strong>Conclusions: </strong>This is the first reported case of small bowel perforation into the retro-rectus space following eTEP Rives-Stoppa repair. Contributing factors included advanced age, high tension in the posterior sheath, pre-existing bowel adhesions, and increased intra-abdominal pressure from postoperative coughing. Surgeons should maintain a high index of suspicion for this life-threatening complication, particularly in elderly or frail patients, and consider early imaging for atypical postoperative symptoms to enable timely intervention.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"223"},"PeriodicalIF":2.4000,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Small bowel perforation into the retro-rectus space following eTEP Rives-Stoppa repair for incisional hernia: a rare and life-threatening complication.\",\"authors\":\"Toshiro Tanioka, Keisuke Okuno, Masanori Tokunaga, Yusuke Kinugasa\",\"doi\":\"10.1007/s10029-025-03407-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The enhanced totally extraperitoneal (eTEP) Rives-Stoppa repair is increasingly adopted for incisional hernia repair due to its minimally invasive approachand favorable outcomes. However, rare but severe complications, such as small bowel perforation into the retro-rectus space, may occur, necessitating prompt recognitionand management.</p><p><strong>Case presentation: </strong>An 80-year-old male underwent eTEP Rives-Stoppa repair for an EHS L2 incisional hernia, involving retro-rectus dissection, transversus abdominis release, and mesh placement. On postoperative day 1, he developed hypotension and extensive subcutaneous ecchymosis, without abdominal pain or fever. Initial computed tomography (CT) revealed a retro-rectus fluid collection suggestive of hemorrhage. By day 2, repeat CT showed increased free air and enteric content, indicating bowel perforation. Emergency laparotomy confirmed a dehiscent posterior rectus sheath with a perforated small bowel segment protruding into the retro-rectus space. The mesh was removed, the affected bowel resected, and temporary abdominal closure was performed due to severe inflammation and edema. The postoperative course was complicated by recurrent bacteremia and abscesses, requiring prolonged antimicrobial therapy and intensive care. The patient recovered and was transferred to a rehabilitation facility six months later.</p><p><strong>Conclusions: </strong>This is the first reported case of small bowel perforation into the retro-rectus space following eTEP Rives-Stoppa repair. Contributing factors included advanced age, high tension in the posterior sheath, pre-existing bowel adhesions, and increased intra-abdominal pressure from postoperative coughing. Surgeons should maintain a high index of suspicion for this life-threatening complication, particularly in elderly or frail patients, and consider early imaging for atypical postoperative symptoms to enable timely intervention.</p>\",\"PeriodicalId\":13168,\"journal\":{\"name\":\"Hernia\",\"volume\":\"29 1\",\"pages\":\"223\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-07-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hernia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10029-025-03407-7\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hernia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10029-025-03407-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Small bowel perforation into the retro-rectus space following eTEP Rives-Stoppa repair for incisional hernia: a rare and life-threatening complication.
Background: The enhanced totally extraperitoneal (eTEP) Rives-Stoppa repair is increasingly adopted for incisional hernia repair due to its minimally invasive approachand favorable outcomes. However, rare but severe complications, such as small bowel perforation into the retro-rectus space, may occur, necessitating prompt recognitionand management.
Case presentation: An 80-year-old male underwent eTEP Rives-Stoppa repair for an EHS L2 incisional hernia, involving retro-rectus dissection, transversus abdominis release, and mesh placement. On postoperative day 1, he developed hypotension and extensive subcutaneous ecchymosis, without abdominal pain or fever. Initial computed tomography (CT) revealed a retro-rectus fluid collection suggestive of hemorrhage. By day 2, repeat CT showed increased free air and enteric content, indicating bowel perforation. Emergency laparotomy confirmed a dehiscent posterior rectus sheath with a perforated small bowel segment protruding into the retro-rectus space. The mesh was removed, the affected bowel resected, and temporary abdominal closure was performed due to severe inflammation and edema. The postoperative course was complicated by recurrent bacteremia and abscesses, requiring prolonged antimicrobial therapy and intensive care. The patient recovered and was transferred to a rehabilitation facility six months later.
Conclusions: This is the first reported case of small bowel perforation into the retro-rectus space following eTEP Rives-Stoppa repair. Contributing factors included advanced age, high tension in the posterior sheath, pre-existing bowel adhesions, and increased intra-abdominal pressure from postoperative coughing. Surgeons should maintain a high index of suspicion for this life-threatening complication, particularly in elderly or frail patients, and consider early imaging for atypical postoperative symptoms to enable timely intervention.
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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