Post-operative volvulus following laparoscopic appendectomy: A case series

Abstract

Introduction: Laparoscopic appendectomy is standard of care for acute appendicitis and commonly involves use of linear staplers for dividing the appendiceal base and mesoappendix. We present a series of a rare complication, postoperative intestinal volvulus from retained staples. Cases: Patients are a 1) 10-year-old male, 2) 13-year-old, and 3) 12-year-old female all diagnosed with acute appendicitis and treated with laparoscopic appendectomy using linear endostapler.Case 1 had abdominal pain 10 days post-operation with peritonitis on exam, leukocytosis, high lactate. CT imaging was concerning for volvulus. Emergent laparotomy reduced the volvulus caused by adhesion to the mesentery from free staples. He was discharged ten days later.Case 2 had emesis and abdominal pain 22 days postoperatively, with CT findings concerning for volvulus. Emergent laparoscopy found an adhesive band from mesentery to terminal ileum involving staples and was reduced. He was discharged the following day.Case 3 had abdominal pain and emesis two days postoperatively. Ultrasound showed hemorrhagic ovarian cyst, and later showed ascites. Pain persisted; STAT CT showed closed loop bowel obstruction requiring emergent laparotomy. A staple was embedded into mesentery with an adhesive band causing a volvulus. Post-operative course was complicated by re-operations and re-admission for additional obstruction. She discharged 14 days after the initial exploratory laparotomy. Conclusion: Post-operative volvulus, a serious complication, can occur following surgical procedures that involve the use of staplers. Free staples left behind in the peritoneal cavity carry a risk of causing such complication. Removal of free staples is recommended at the conclusion of any operation where staples are used.

Keywords

• Case series
• Laparoscopic appendectomy
• Volvulus