Post-operative volvulus following laparoscopic appendectomy: A case series

Introduction:Laparoscopic appendectomy is standard of care for acute appendicitis and com- monly 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 in- volving staples and was reduced. He was discharged the following day.Case 3 had abdominal pain and emesis two days postoperatively. Ultrasound showed hemor- rhagic 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 ad- hesive 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 laparo- tomy.Conclusion:Post-operative volvulus, a serious complication, can occur following surgical proce- dures 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.