Introduction: Port-site hernia (PSH), a complication of laparoscopic surgery, is extremely rare in obstetrics and gynecology. We report a case of hernia at a 5-mm port site used for drain placement after laparoscopic surgery.

Case presentation: A 46-year-old woman (gravida two, para two) with a giant right ovarian tumor underwent laparoscopic right adnexectomy lasting 99 min with minor blood loss. She recovered and was discharged 4 days postoperatively. However, an adult granulosa cell tumor was diagnosed, and 41 days postoperatively she underwent another operation comprising laparoscopic hysterectomy, left adnexectomy, omentectomy, and pelvic lymphadenectomy, lasting 305 min (blood loss: 98 mL). Drain placement was through a left lower abdominal 5-mm port site, with removal 1 day postoperatively. She remained stable after resuming oral intake and was discharged 6 days postoperatively. She visited our department 8 days postoperatively with a chief complaint of left lower abdominal pain, where a lump was observed. Contrast-enhanced computed tomography revealed intestinal obstruction from the port site, leading to a diagnosis of PSH requiring emergency surgery. The port site scar was incised and extended an additional 5 cm. Intestinal obstruction with no ischemic change was confirmed. After hernia reduction, the peritoneum and fascia were closed. She recovered and was discharged 7 days postoperatively.

Conclusion: Drain placement through the port scar was possible causative factor of PSH. Sufficient measures to prevent PSH are crucial even for a 5-mm port site in high-risk patients.