Acute Large Bowel Obstruction Post Umbilical Hernia Repair Surgery: A Case Report

While large bowel obstruction (LBO) is a less common cause of bowel obstruction, it has a broad range of differentials. Its most common etiology in the United States is colorectal adenocarcinoma. Patients usually present with diffuse abdominal pain, constipation, abdominal distension, and nausea. Abdominal X-rays can quickly assess bowel dilation, but a CT scan is the gold standard to determine the location and severity of the blockage. The treatment can range from IV fluid to emergent colectomy. A 41-year-old male with a history of bronchitis and hypertension presented for a surgical consult six days post-incarcerated umbilical hernia repair. The patient complained of nausea, diffuse abdominal distension and tenderness, and inability to pass gas. Physical examination revealed a severely distended abdomen with rebound and guarding at the lower right quadrant. CT scan showed severely dilated ascending colon and cecum along with pneumatosis. There was also an obstructing mass at the sigmoid colon. A diagnosis of severe LBO with impending perforation was made, and the patient underwent emergent exploratory laparotomy. Subtotal colectomy was done with anastomosis between the ileum and sigmoid colon. The pathology report showed an 8.0 cm dilated cecum, necrosis of the ascending colon, and diverticulitis with scar fibrosis along the wall of the colonic membrane. The patient had an ileus and kidney injury postoperatively but they subsequently resolved. Diverticulitis is historically common in the elderly population, but recent studies have shown a rising incidence among younger individuals. It is a common cause of obstruction but rarely causes severe complications like pneumatosis and perforation that require emergent surgery. When occluded, the mass and patent ileocecal valve can cause closed-loop bowel syndrome. Even though an unhealthy diet is a known trigger for diverticulitis, surgery is possibly another factor in rare cases. Patients of all ages should be educated on the symptoms of diverticular disease, and surgical monitoring is key in those with known diverticulosis.