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• W4385778848 abstract "A 36-year-old woman presented with 1 day of sudden onset generalized abdominal pain 6 days after an appendicectomy which required a partial caecectomy in the context of failure of Endoloop® (J&J) ligature from poor tissue quality. Her post-operative recovery was uncomplicated and she was discharged home. During her re-presentation, her observations and laboratory markers were within normal limits, however she was profoundly tender in the right lower quadrant of the abdomen with rebound tenderness. Contrast-enhanced computer tomography (CT; Fig. 1a) demonstrated large volume free gas and distended ileal loops. The decision was made for urgent laparoscopic intervention, which found a deformed staple at the staple line edge adhering to the adjacent small bowel mesentery causing a ‘bridge’ resulting in an internal hernia with early evolving small bowel obstruction (Fig. 1b,c). The pressure distention in the patulous caecum likely resulted in the pneumoperitoneum that arose through the staple line. Definitive treatment was decided and a laparoscopic right hemicolectomy was performed. She recovered well from this and was discharged on the sixth post-operative day. The use of linear cutting staplers in appendicectomy is common practice in many parts of the world either as first-line management of the appendiceal base, or as an adjunct when there is failure of ligature techniques. Complications of such stapling devices in gastrointestinal surgery is considered rare, with the majority of concerns relating to staple line leakages,1 although there are published cases of staples causing obstruction2-7 due to adhesions,4, 7 volvulus5 and internal herniation,6 and even a case of perforation8 due to erosion as put forward by the authors in a previous publication. Given the risk of device related complications, the authors support the notion that an exposed staple line in the caecum represents a potential risk for the development of post-operative complications that include bleeding, perforation and leak from the staple line, and adhesions that can form between parietal and visceral structures to the staple line. Therefore, if stapled appendicectomy is required, the authors recommend oversewing of the staple line, or to avoid stapled appendicectomy altogether by using a ligature loop followed by laparoscopic suturing to bury the appendiceal stump analogous to the technique used in an open appendicectomy. Terence C. Chua: Conceptualization; Project administration. Stephanie E. Cornish: Data curation; Finalization. Terence C. Chua, Stephanie E. Cornish: Drafting; Review and Editing. Informed consent was obtained from the patient for permission to present this case for an educational purpose in an anonymous manner." @default.
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• W4385778848 date "2023-08-11" @default.
• W4385778848 modified "2023-10-17" @default.
• W4385778848 title "Endoscopic stapled appendicectomy mishap" @default.
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• W4385778848 doi "https://doi.org/10.1111/ans.18652" @default.
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