Successful Laparoscopic Management of Pericaecal Hernia Causing Small Bowel Obstruction

Management of small bowel obstruction varies depending on the cause and clinical status of patients. While most cases can be managed conservatively, a not-insignificant proportion of patients undergo surgical intervention. Laparotomy has long been the default approach for entering the abdomen in cases requiring surgical intervention, with laparoscopy largely being avoided due to abdominal distension and the risk of perforating bowels on entry. We present here the case of a 54-year-old woman who presented with signs and symptoms as well as radiological evidence of a closed-loop small bowel obstruction in her right lower quadrant. Following a brief period of nasogastric decompression, her abdominal distension improved, allowing for a laparoscopic entry where a pericaecal hernia was noted to be the cause of her obstruction. Extensive adhesiolysis without the use of an energy device successfully allowed for the reduction of the bowel contained within. No bowel resection was performed and the patient was discharged home on day 3 following her procedure. This case report successfully demonstrates the utility of using laparoscopy as an alternative to laparotomy in patients with a small bowel obstruction secondary to an internal hernia.