Large bowel ischemia following laparoscopic inguinal hernioplasty.

The adverse physiological effects of pneumoperitoneum are well understood. However, the clinical implications of compromised mesenteric circulation through several mechanical and physiological mechanisms are not as well recognized. We describe a fatal case of large bowel ischemia following an elective laparoscopic transperitoneal inguinal hernioplasty. The patient was a 78-year-old man who died within 30 h after an uneventful anesthesia and laparoscopic surgery. An autopsy revealed thrombosis of the inferior mesenteric artery and an infrarenal aortic aneurysm with thrombotic plaque on its wall. We reviewed the relevant literature on laparoscopic procedures and mesenteric ischemia. To our knowledge, this is the first reported case of large bowel ischemia following pneumoperitoneum. We conclude that the presence of an aortic aneurysm is an added risk factor in laparoscopy.