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Fístula intestinal posoperatoria tras herniorrafía umbilical por hernia de Richter insospechada

2020; CIG Media Group; Volume: 8; Issue: 2 Linguagem: Inglês

2255-2677

Manuel Grez Ibáñez, Heyssel Carmona Alvarado, Constanza Ocampo,

Hernia repair and management

espanolIntroduccion: La cirugia de urgencias de la hernia umbilical tiene complicaciones graves que pueden poner en riesgo la vida de los pacientes. Caso clinico: Varon de 60 anos que ingresa de urgencia con pequena hernia umbilical de larga evolucion con atascamiento de pocas horas; reduccion espontanea, pero con persistencia del dolor que motivo la realizacion de cirugia de urgencia. Se realizo herniorrafia umbilical previa observacion «aparente» de ausencia de complicacion intraabdominal. Al dia siguiente, se produjo una fi ltracion de liquido intestinal a traves de la herida operatoria. Tras una relaparotomia urgente, se confi rma una peritonitis intestinal masiva por perforacion en asa yeyunal que es tratada mediante sutura, que evoluciona sin complicaciones. Discusion: Se presenta una complicacion grave que paso desapercibida por una exploracion intraoperatoria insufi ciente ante la aparente «simplicidad» de la patologia herniaria y de la tecnica quirurgica. La fistula posoperatoria precoz y su resolucion por reintervencion inmediata evito la previsible evolucion compleja de alto riesgo. EnglishIntroduction: The emergency surgery of the umbilical hernia has serious complications that can put at risk the life of the patients. Case report: A 60-year-old man admitted to hospital with a small long-term umbilical hernia with a few hours of blockage, a spontaneous reduction but with persistent pain that led to emergency surgery. Umbilical herniorrhaphy was performed after “apparent” observation of absence of intra-abdominal complication. The next day, leakage of intestinal fl uid through the operative wound. After urgent relaparotomy, massive intestinal peritonitis is confi rmed by jejunal loop perforation, which is treated by suture, evolving without complications. Discussion: A serious complication that went unnoticed due to an insuffi cient intraoperative exploration before the apparent “simplicity” of the hernia pathology and the surgical technique. The early postoperative fi stula and its resolution by immediate reintervention avoided the foreseeable complex evolution of high risk.