Emergency Tapp for Strangulated Hernia. Safe Option or Road to Disaster? Case Report

Background Laparoscopic approach to strangulated hernia is controversial and there are only few papers on this topic. We present a case of emergency TAPP and complications that occurred during and after surgery. Case presentation A 68-year-old female came to the emergency department with complaints of right inguinal bulging, abdominal pain and vomiting. Abdominal ultrasound and X-ray confirmed small bowel strangulation. Manual reduction was unsuccessful, so we proceeded to emergency laparoscopic surgery which showed femoral hernia with strangulation of small bowel and omental adhesions in the right iliac fossa. After adhesiolysis, reduction of herniated small bowel was achieved. Bowel was congested but peristalsis was present. We continued to repair hernia by TAPP approach. After completion, bowel was inspected and it was concluded that there were no signs of ischemia. 4 hours after the surgery patient became hypotensive and tachycardic. Abdominal CT scan showed hematoma with active bleeding. We proceeded to emergency laparotomy and saw hematoma spreading from liver to the right inguinal region. Hemostasis was achieved by suturing the bleeding vessel on omentum. Because of the suspected bowel ischemia we decided to do resection. During procedure attempts of placing central venous catheter failed. After the surgery chest X-ray showed complete right sided pneumothorax, which was drained. Patient was discharged with full recovery. There were no signs of mesh infection or recurrence. Conclusion Emergency TAPP for strangulated hernia should be done by an experienced surgeon. In the postoperative course one should expect complications which are uncommon in elective setting.