Background: The Pfannenstiel incision has wide application in gynecologic and lower abdominal surgery. Current recommendations regarding the closure of the incision suggest that there is no justification in closure of the parietal peritoneum, as there is no apparent benefit and potentially greater short-term complications. However, non-closure itself may have its risks. Case: Two women ages 42 and 59 years, respectively, presented with acute small bowel obstruction a few days after gynecologic surgery via Pfannenstiel incisions. Closure of the incisions had not involved closure of the peritoneum or approximation of the rectus muscles in the midline. In both cases, a loop of small bowel was found herniating between the rectus abdominis muscles into a space underneath the closed rectus sheath. Results: In both cases, reduction of the loop resulted in complete recovery. Conclusions: Although rare, non-closure of the peritoneum in the Pfannenstiel incision may give rise to potentially serious internal herniation. The authors suggest approximation of the recti in the event of peritoneal non-closure. (J GYNECOL SURG 28:290)
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