Prolonged Ileus Due to Underlying Shigella Infection After Bilateral Open Inguinal Hernia Repair

TL;DR

A man developed prolonged ileus after hernia surgery due to a rare Shigella infection, which resolved with antibiotics.

Contribution

Highlights Shigella infection as a rare but important cause of postoperative ileus in adults.

Findings

Prolonged ileus occurred eight days after hernia repair due to Shigella infection.

Symptoms resolved after targeted antibiotic treatment.

Shigellosis should be considered in postoperative ileus differential diagnosis.

Abstract

We present a rare case of prolonged ileus caused by underlying Shigella infection after surgical hernia repair. Infectious disease is an uncommon cause of postoperative prolonged ileus in adults.

Our 48-year-old male patient underwent bilateral open inguinal hernia repair and open umbilical hernia repair without complication at an academic institution, with same-day discharge. Eight days later, he presented to the emergency department with complaints of severe cramping abdominal pain, nausea, emesis, and watery diarrhea. Physical examination, computed tomography scan of the abdomen and pelvis, and abdominal X-ray were initially concerning for bowel obstruction. The patient was admitted to the general surgery service. Concern for ileus with underlying gastritis arose after a small bowel follow-through showed contrast eventually reaching the rectum. A subsequent gastrointestinal pathogens panel was positive for Shigella. The patient’s symptoms resolved after appropriate antibiotic treatment. Shigellosis and other infectious diseases should be considered in the differential diagnosis of postoperative prolonged ileus.

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