Offending staple as an unusual but preventable cause of internal hernia with bowel obstruction Case report and review of the Literature

In the laparoscopic era, the use of the stapler is a common practice and it adds to the possible causes of post-operative bowel adhesions with obstruction. In this study, we reviewed the Literature in order to study the pathogenesis and the incidence of bowel obstruction after using the laparoscopic stapler. Furthermore, we report a case of a woman who went to our observation for incoming bowel obstruction after laparoscopic ileal resection. In the emergency setting, the laparoscopic exploration revealed that a staple created adherence between an intestinal loop and its mesentery with consequent internal hernia and volvulus. The patient was treated by laparoscopy with removal of the offending staple and resection of the intestinal necrotic segment. Tips and tricks of the surgical technique for avoiding such rare but threatful complication, are discussed. KEY WORDS: Internal hernia, Mechanical bowel obstruction, Laparoscopic stapler, Volvulus.