SMALL BOWEL OBSTRUCTION SECONDARY TO ABDOMINAL WALL ABSCESS STATUS POST COLECTOMY

Objectives: Patient is a 49-year-old male who presented to the hospital for scheduled robotic assisted right colon resection. The indication for the procedure being endoscopically unresectable tubulovillous adenoma polyp. Postoperatively, patient was reporting flatus and bowel movements, however remained intermittently febrile and tachycardic. Patient became distended postoperatively CT showed evidence of small bowel obstruction with transition point distal to the site of anastomosis. Patient did become obstipated and ceased having bowel movements. Attempted trial of conservative management, with nasogastric tube placement, did not relieve patient’s small bowel obstruction. Decision was made to take the patient back to the operating room for exploratory laparotomy with planned lysis of adhesions. Intraoperatively, the small bowel mesentery was found adherent to the abdominal wall at site of prior trocar placement. The incisional site was probed and found to communicate with lateral abdominal wall abscess cavity. The abscess cavity was drained and packed. Postoperatively, patient recovered without complications and saw return of bowel function. This case provides an example for a unique cause of early post operative small bowel obstruction and the need to ensure adequate hemostasis at port sites in minimally invasive procedures. In this case the abscess was likely formed secondary to infected hematoma.

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