Volvulus caused by a free intraperitoneal staple after laparoscopic appendectomy: A case report

Area of Science:

• Gastrointestinal Surgery
• Minimally Invasive Procedures
• Surgical Complications

Background:

• Laparoscopic appendectomy commonly utilizes linear staplers.
• Complications from free intraperitoneal staples post-appendectomy are rarely reported.
• This case highlights a unique complication: volvulus caused by a free staple.

Purpose of the Study:

• To report the first case of small bowel volvulus secondary to a free staple after laparoscopic appendectomy.
• To emphasize the potential for serious complications from seemingly inert free staples.
• To raise awareness among surgeons regarding this rare complication.

Main Methods:

• A 27-year-old female underwent laparoscopic appendectomy using a gastrointestinal anastomosis (GIA) stapler.
• The patient presented 8 days post-discharge with symptoms of bowel obstruction.
• Diagnosis was confirmed via CT scan, followed by exploratory laparotomy and small bowel resection.

Main Results:

• A malformed, free staple was found causing a closed-loop obstruction and necrosis of a small bowel segment.
• The affected small bowel segment required resection.
• The patient recovered without further perioperative complications.

Conclusions:

• Free intraperitoneal staples, though generally considered inert, can cause severe complications like volvulus.
• A high index of suspicion is crucial for early diagnosis in postoperative appendectomy patients with obstructive symptoms.
• Preventive measures include meticulous inspection of the staple line and removal of any free, malformed staples during surgery.