腎臟移植術後早期切口疝氣併小腸絞窄需緊急手術治療之病例報告

黃國倫¹、吳俊賢^1、2、林嘉祥^1、2、王華斌¹

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

Early Post Renal transplant Incisional Hernia with Small Bowel Strangulation Requiring Emergency Surgery
Guo-Lun Huang¹, Chun-Hsien Wu^1,2, Victor C. Lin^1,2, Hua-Ping Wang¹

¹ Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

² School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Introduction: Incisional hernia (IH) is an uncommon but recognized complication after renal transplant. A systematic review reported a mean incidence of approximately 3.2%, with rates ranging from 1.1% to 7.0% among renal transplant recipients. Several risk factors have been associated with the development of incisional hernia after transplantation, including obesity, diabetes mellitus and advanced age. Although many incisional hernias remain asymptomatic, complications such as bowel incarceration and strangulation may occur and require urgent surgical intervention. Here we present a case of incisional hernia with small bowel incarceration and strangulation shortly after renal transplant, requiring emergent surgical intervention.

Case report: A 47-year-old woman with a medical history of diabetes mellitus, hypertension, spontaneous intracranial hemorrhage, and end-stage renal disease (ESRD) requiring hemodialysis presented to the emergency department with a two-day history of nausea, vomiting, and right lower abdominal pain, occurring approximately one month after cadaveric kidney transplantation. Her body mass index (BMI) was 33.64 kg/m², indicating obesity, a recognized risk factor for incisional hernia following renal transplant. On physical examination, a tender bulging mass was noted at the right lower abdominal transplant incision site, without signs of generalized peritonitis. Laboratory evaluation revealed bandemia and acute kidney injury accompanied by metabolic acidosis. Non-contrast abdominal computed tomography demonstrated a right lower abdominal wall hernia containing small bowel loops with associated bowel dilatation and fluid accumulation, raising concern for incarceration with possible strangulation (Fig. 1A). Given the concern for bowel strangulation, emergent surgical intervention was undertaken. Intraoperative findings revealed an incisional hernia sac containing incarcerated small bowel with hemoperitoneum, and the affected bowel segment showed ischemic changes (Fig. 1B). Incisional hernia repair with small bowel resection was therefore performed. Postoperatively, the patient was transferred to the surgical intensive care unit (SICU) for close monitoring. She was successfully extubated the following day and received parenteral nutritional support. Her diet was gradually advanced as tolerated, and renal function progressively improved. The patient was discharged in stable condition on postoperative day 8. Subsequent follow-up imaging demonstrated resolution of the previously noted fluid collection, and the patient remained clinically stable.

Conclusion: IH is an uncommon but important complication following renal transplant. Risk factors such as obesity and diabetes may contribute to impaired wound healing and fascial weakness. While many cases are asymptomatic, bowel incarceration and strangulation represent surgical emergencies requiring prompt intervention. Early recognition of symptoms and timely imaging are essential for diagnosis. In renal transplant recipients, careful postoperative monitoring and risk factor modification, such as weight control and glycemic control, may help reduce recurrence and improve outcomes.