Unusual presentation of trocar site hernia after Roux-en-Y gastric bypass: case report.

Loret, Nele; De Visschere, Marieke; Berwouts, Luc

INTRODUCTION The exponential increase of bariatric surgery has resulted in a new diagnostic field of postoperative complications. One of the possibly serious complications is trocar site hernia. CASE REPORT We present a rare case of trocar site hernia, in particular herniation of the blind loop of the jejunojejunostomy in a patient previously operated for laparoscopic gastric bypass. CONCLUSION In patients with intermittent epigastric pain and regurgitation or nausea after RYGB, the differential diagnosis should include internal herniation and cholecystitis. Besides that, incarcerated trocar site hernia should also be considered. If obstructive symptoms are lacking, this might indicate Richter's hernia or herniation of the blind loop of the jejunojejunostomy. Due to the vague symptoms and the potentially late presentation, diagnosis can be challenging. However, this is a dangerous complication possibly leading to bowel strangulation and perforation, requiring urgent surgical repair.