Abstract
Background:
Early postoperative mechanical intestinal obstruction is rare, with the commonest cause being adhesions. The wide application of minimally invasive surgeries has increased the incidence of Richter's hernia.
Case:
A 63-year old, morbidly obese lady diagnosed with carcinoma of the uterine cervix underwent laparoscopic radical hysterectomy under general anesthesia. Two 10-mm ports were used—one in the umbilical area for a camera and the other in the right iliac fossa as a working port. Three 5-mm ports were also used. The procedure was completed without any intraoperative complications and a specimen was retrieved per her vagina. Postoperatively, this patient developed protracted bilious vomiting from day 2, which was managed conservatively for the first 8 days and was finally diagnosed to be Richter's hernia with contrast-enhanced computerized tomography (CECT). The patient was reexplored laparoscopically and managed successfully without any bowel ischemia or gangrene.
Results:
Following the second surgery, this patient recovered rapidly and was discharged to go home on a full diet by the fifth postoperative day.
Conclusions:
A strong clinical suspicion should alert the surgeon to consider CECT early in the postoperative course to diagnose and manage Richter's hernia.
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