Hernia de Spiegel como causa de obstrucción intestinal de íleon en una paciente anticoagulada por fibrilación auricular, abordaje laparoscópico. Reporte de caso.

Introduction: Spiegel's hernia is a rare type of lateral hernia on the abdominal wall. Once it is diagnosed, it may be convenient to undergo surgery because of the high risk of complications. Case report: We present the case of a patient with history of atrial fibrillation anticoagulated with Apixaban. She went to the emergency department with signs and symptoms of intestinal obstruction. The diagnose was confirmed by abdominal tomography: Incarcerated left Spiegel hernia. We decided to wait 24 hours to ensure the anticoagulant clearance, with the idea of avoiding the risk of bleeding in surgery; we considered not to wait 48 hours as recommended by the drug guidelines. avoiding as far as possible the progression of the disease and preventing a possible intestinal perforation. To prevent massive bleeding due to less parietal trauma the approach was performed laparoscopically with the IPOM technique. The patient did not present complications on surgery and 12 months later it remains without recurrence of illness. Discussion: Our case shows a dilemma of medical treatment, the patient had a high risk of necrosis and intestinal perforation in case of not being operated, but also surgery represents a risk of bleeding due to being anticoagulated with Apixaban (Eliquis (R)), a medicine that does not have antidote to reverse its effect. We considered that the risk of perforation or necrosis was greater than the risk of bleeding, that is why we decided that the surgical process should be made with 24 h of latency (not 48 h). A laparoscopic approach was decided because it is the one with the lowest risk of bleeding for us.