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Fujiwara R, Yano M, Matsumoto M, Higashihara T, Tsudaka S, Hashida S, Ichihara S, Otani H. Two cases of strangulated bowel obstruction due to exposed vessel and nerve after laparoscopic and robot-assisted lateral lymph node dissection (LLND) for rectal cancer. Surg Case Rep 2024; 10:85. [PMID: 38619675 PMCID: PMC11018568 DOI: 10.1186/s40792-024-01889-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The majority of small bowel obstructions (SBO) are caused by adhesion due to abdominal surgery. Internal hernias, a very rare cause of SBO, can arise from exposed blood vessels and nerves during pelvic lymphadenectomy (PL). In this report, we present two cases of SBO following laparoscopic and robot-assisted lateral lymph node dissection (LLND) for rectal cancer, one case each, of which obstructions were attributed to the exposure of blood vessels and nerves during the procedures. CASE PRESENTATION Case 1: A 68-year-old man underwent laparoscopic perineal rectal amputation and LLND for rectal cancer. Four years and three months after surgery, he visited to the emergency room with a chief complaint of left groin pain. Computed tomography (CT) revealed a closed-loop in the left pelvic cavity. We performed an open surgery to find that the small intestine was fitted into the gap between the left obturator nerve and the left pelvic wall, which was exposed by LLND. The intestine was not resected because coloration and peristalsis of the intestine improved after the hernia was released. The obturator nerve was preserved. Case 2: A 57-year-old man underwent a robot-assisted rectal amputation with LLND for rectal cancer. Eight months after surgery, he presented to the emergency room with a complaint of abdominal pain. CT revealed a closed-loop in the right pelvic cavity, and he underwent a laparoscopic surgery with a diagnosis of strangulated SBO. The small intestine was strangulated by an internal hernia caused by the right umbilical arterial cord, which was exposed by LLND. The incarcerated small intestine was released from the gap between the umbilical arterial cord and the pelvic wall. No bowel resection was performed. The umbilical arterial cord causing the internal hernia was resected. CONCLUSION Although strangulated SBO due to an exposed intestinal cord after PL has been a rare condition to date, it is crucial for surgeons to keep this condition in mind.
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Affiliation(s)
- Ryota Fujiwara
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan.
| | - Masaaki Yano
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Makoto Matsumoto
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoaki Higashihara
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Shimpei Tsudaka
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Shinsuke Hashida
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Shuji Ichihara
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Hiroki Otani
- Department of Gastroenterology and General Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
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Khalid A, Ashraf A, Salman MA, Newton RC. Internal Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review. Cureus 2023; 15:e42960. [PMID: 37667721 PMCID: PMC10475313 DOI: 10.7759/cureus.42960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/06/2023] Open
Abstract
Internal abdominal hernias are rare entities that most commonly present with acute small bowel obstruction. These hernias can be congenital or acquired. While congenital hernias are considered the most common type, acquired hernias are becoming more common. Recently, a rare type of internal herniation has been reported underneath iliac vasculature in patients who have undergone pelvic lymph node dissection in the past. This study was carried out to assess the prevalence of this rare type of internal hernia. Two reviewers searched the literature in three online databases using the Cochrane methodology for systematic reviews. The search of databases yielded 70 articles. The studies which reported internal herniation underneath iliac vasculature were included. Studies that reported herniation underneath other pelvic organs or vasculature were excluded. After screening, 17 articles were deemed suitable and selected. All 17 cases reviewed underwent pelvic lymph node dissection in the past. The median latency period between index surgery and clinical presentation with the incarcerated hernia was 20 months. All 17 cases were managed surgically with small bowel resection carried out in 13 cases. Eleven authors reported closing the hernia defect with various techniques, while five decided not the close it. All 17 cases were alive at the time of discharge from the hospital, with a mean hospital stay of 12.7 days. Given our findings, there should be a high index of suspicion of internal hernia in patients presenting with small bowel obstruction with a history of pelvic lymph node dissection. In our review, internal herniation was always preceded by pelvic lymph node dissection, so the closure of the peritoneum should be considered while pelvic lymph node dissection is carried out.
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Affiliation(s)
- Aizaz Khalid
- General Surgery, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Chichester, GBR
| | - Anza Ashraf
- General Surgery/Urology, Frimley Health National Health Service (NHS) Foundation Trust, Slough, GBR
| | - Mohamed A Salman
- General Surgery, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Chichester, GBR
- General Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Richard C Newton
- General Surgery, University Hospitals Sussex National Health Service (NHS) Foundation Trust, Chichester, GBR
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3
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Khalid A, Salman MA, Woodhams S, Newton RC. Strangulated Small Bowel Internal Hernia Under the External Iliac Artery After Robotic Cystoprostatectomy. Cureus 2023; 15:e39837. [PMID: 37397665 PMCID: PMC10314784 DOI: 10.7759/cureus.39837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Small bowel obstruction is a common surgical pathology encountered in the emergency department. The most common cause of small bowel obstruction is adhesions secondary to previous abdominal surgery. While strangulated external hernias are also a common cause of obstructions encountered, internal hernias leading to obstruction are rare. We present a 76-year-old male who presented with an acute abdomen and was later diagnosed with an internal hernia underneath his right external iliac artery. Internal herniation underneath the iliac vasculature is a recent phenomenon encountered very rarely after the natural anatomy has been disturbed in patients who have undergone pelvic lymph node dissection. Patients with a previous history of pelvic lymph node dissection should be suspected of having an internal hernia if they present with an acute abdomen. Closure of the peritoneum should also be considered in these patients as it may help prevent herniation.
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Affiliation(s)
- Aizaz Khalid
- General Surgery, University Hospitals Sussex NHS Foundation Trust, Chichester, GBR
| | - Mohamed A Salman
- General Surgery, University Hospitals Sussex NHS Foundation Trust, Chichester, GBR
| | - Simon Woodhams
- Urology, University Hospitals Sussex NHS Foundation Trust, Chichester, GBR
| | - Richard C Newton
- General Surgery, University Hospitals Sussex NHS Foundation Trust, Chichester, GBR
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Zanca KM, Marcantonio M, Pini R, Mongelli F, La Regina D, Cianfarani A. Intestinal ischemia due to internal hernia beneath the right external iliac artery after laparoscopic hysterectomy and lymphadenectomy: A case report. Int J Surg Case Rep 2023; 106:108187. [PMID: 37058801 PMCID: PMC10130623 DOI: 10.1016/j.ijscr.2023.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The occurrence of an internal hernia beneath the external iliac artery is rare but may occur after pelvic lymphadenectomy. The challenging treatment of this rare condition should be tailored to the patient's clinical and anatomical characteristics. CASE PRESENTATION We present the case of a 77-year-old woman with previous history of laparoscopic hysterectomy and adnexectomy with extended pelvic lymphadenectomy for endometrial cancer. The patient was admitted in the emergency department because of severe abdominal pain and a computed tomography scan showed signs of internal hernia. The laparoscopy confirmed such a finding below the right external iliac artery. A small bowel resection was deemed necessary and the defect was closed with an absorbable mesh. The post-operative course was uneventful. CLINICAL DISCUSSION Internal hernia beneath the iliac artery is a rare condition after pelvic lymphadenectomy. The first challenge is the hernia reduction, which can be safely carried out laparoscopically. Secondly, a patch or a mesh should be used to close the defect if a primary peritoneal suture is not feasible, but it requires to be fixed in the small pelvis. The use of absorbable material is a valuable option and should leave a fibrotic area that covers the hernia defect. CONCLUSION A strangulated internal hernia beneath the external iliac artery is a possible complication after extensive pelvic lymph node dissection. The laparoscopic approach to treat bowel ischemia and to close the peritoneal defect with a mesh, should reduce as much as possible the risk of internal hernia recurrence.
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Affiliation(s)
- Kostas Mario Zanca
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, 6500 Bellinzona, Switzerland.
| | - Maria Marcantonio
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, 6500 Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, 6500 Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, 6500 Bellinzona, Switzerland; Faculty of Biomedical Science, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, 6500 Bellinzona, Switzerland; Faculty of Biomedical Science, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Agnese Cianfarani
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, 6500 Bellinzona, Switzerland
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Chowdary PB, Wright C. Ileal Obstruction Secondary to Internal Hernia Under the External Iliac Artery: A Case Report and Literature Review. Cureus 2022; 14:e28107. [PMID: 36127993 PMCID: PMC9480860 DOI: 10.7759/cureus.28107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/06/2022] Open
Abstract
Bowel obstruction is one of the most common causes of surgical admission. Most of these patients are managed with non-operative management, often resolving 24 to 48 hours after admission. If conservative management fails in patients with adhesional bowel obstruction, surgery is usually the only other option. Surgery often involves the division of adhesions and resection of the non-viable intestine. Occasionally, unexpected findings require quick but safe interventions, including discussions with other specialities. This report presents a patient who had previously undergone robotic radical cystectomy, pelvic lymphadenectomy and ileal conduit formation. He was admitted with bowel obstruction and failed conservative management. During laparotomy, a loop of ileum had herniated under the right external iliac artery and was ischaemic necessitating resection-anastomosis. We discuss the management of this patient and the available literature regarding this rare presentation.
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6
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Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports. Surg Case Rep 2022; 8:104. [PMID: 35644816 PMCID: PMC9148868 DOI: 10.1186/s40792-022-01459-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/24/2022] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Although small bowel obstruction (SBO) is a major complication occurring after abdominal surgery, few reports have described strangulated SBO after pelvic lymphadenectomy (PL). This report describes two cases of strangulated SBO caused by a skeletonized obturator nerve and pelvic vessels after laparoscopic PL during gynecologic surgery.
Case presentation
Case 1: A 57-year-old woman with endometrial cancer underwent a laparoscopic semi-radical total hysterectomy with PL. Nine months after the operation, she visited our emergency room complaining about subacute pain spreading in the right groin, right buttock, and dorsal part of the right thigh. She had no abdominal pain. Although her symptoms were not typical, computed tomography (CT) revealed strangulated SBO in the right pelvis. Laparoscopic surgery revealed that the small bowel was ischemic. Then we converted to open surgery. We transected the right obturator nerve and umbilical artery, which constructed an internal hernia orifice in the right pelvis, followed by resection of the ischemic small bowel. Fortunately, during 6-month follow-up, she showed only slight difficulty in walking as a postoperative complication. Case 2: A 62-year-old woman with cervical cancer underwent laparoscopic radical hysterectomy with PL. Six months after the operation, she visited our hospital emergently because of sudden onset of abdominal pain and vomiting. CT showed strangulated SBO. Urgent laparoscopic surgery exhibited the incarcerated small bowel at the right pelvis. Consequently, we converted to open surgery. The terminal ileum was detained into the space constructed by the right umbilical artery. We cut the umbilical artery and performed ileocecal resection. After the surgery, she was discharged with no complication or sequela.
Conclusion
When examining a patient after PL who complains of severe pain or symptoms, one should consider the possibility of PL-related SBO, even if the pain is apparently atypical for SBO.
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Robinson IS, Blasdel G, Bluebond-Langner R, Zhao LC. The Management of Intra-abdominal Complications Following Peritoneal Flap Vaginoplasty. Urology 2022; 164:278-285. [PMID: 35150666 DOI: 10.1016/j.urology.2022.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the authors' experience diagnosing and managing intra-abdominal complications following robotic peritoneal flap vaginoplasty. The peritoneal flap vaginoplasty is a technique used to achieve consistent vaginal depth regardless of available natal tissue. Intra-abdominal complications following robotic peritoneal flap creation are rare but prompt diagnosis and management is critical to preventing patient harm. Given the infancy of the technique there is limited data on associated complications and their management. METHODS Retrospective chart review identified patients undergoing robotically assisted peritoneal flap vaginoplasty by the senior authors between 2017 and 2020 who subsequently developed intra-abdominal complications requiring readmission and/or return to the operating room. Patient charts were analyzed for preoperative demographics, medical comorbidities, intraoperative details, postoperative complication presentation, diagnosis, management, and long-term outcomes. RESULTS Out of 274 patients undergoing peritoneal flap vaginoplasty during the study period, six patients were identified who developed intra-abdominal complications (2.2%). One patient developed a postoperative hematoma requiring return to the operating room for diagnostic laparoscopy and hematoma evacuation. Two patients developed intraabdominal abscesses requiring diagnostic laparoscopy and abscess drainage. One patient developed recurrent episodes of small bowel obstructions that resolved with bowel rest. Two patients developed incarcerated internal hernias requiring diagnostic laparoscopy and internal hernia reduction. In one case, the hernia occurred at the peritoneal flap closure site, and in the other case the hernia occurred at the peritoneal flap donor site. CONCLUSIONS Intra-abdominal complications following robot assisted peritoneal flap vaginoplasty are rare. In addition to hematoma and abscess, small bowel incarceration and internal hernias are potential complications of peritoneal flap vaginoplasty that require prompt attention.
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Affiliation(s)
- Isabel S Robinson
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | | | | | - Lee C Zhao
- Department of Urology, NYU Langone Health, New York, NY.
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8
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A retrospective study of internal small bowel herniation following pelvic lymphadenectomy for gynecologic carcinomas. Sci Rep 2021; 11:1441. [PMID: 33446912 PMCID: PMC7809471 DOI: 10.1038/s41598-021-81160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022] Open
Abstract
After pelvic lymphadenectomy (PLA), pelvic vessels, nerve, and ureter are skeletonized. Internal hernias beneath the skeletonized pelvic structure following pelvic lymphadenectomy (IBSPP) are a rare complication following PLA. To the best of our knowledge, only 12 IBSPP cases have been reported and clinical details on such hernias remain unknown.
The aim of the study was to investigate the incident and etiology of IBSPP. 1313 patients who underwent open or laparoscopic pelvic lymphadenectomy were identified from our database. A retrospective review was performed. Mean follow-up period was 33.9 months. A total of 12 patients had IBSPP. Multivariate analysis of laparoscopic surgeries group as compared to open surgeries group, para-aortic lymphadenectomy rate, number of dissected lymph nodes by PLA, antiadhesive material use rate, and blood loss were lower in laparoscopic surgeries group: odd ratio (OR) = 0.13 [95% confidence interval (CI) 0.08–0.19], and OR = 0.70 [95% CI 0.50–0.99], OR = 0.17 [95% CI 0.10–0.28], OR = 0.93 [95% CI 0.92–0.94]. However, no significant difference was observed in the incidence of IBSPP between laparoscopic surgery (1.0%) and open surgery (0.8%). All IBSPP occurred in the right pelvic space. These findings may contribute to the development of prevention methods for this disease.
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9
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Uehara H, Yamazaki T, Kameyama H, Iwaya A, Gohda Y, Chinen I, Kubota A, Aoki M, Kobayashi K, Sato D, Yokoyama N, Kuwabara S, Otani T. Internal hernia beneath the obturator nerve after robot-assisted lateral lymph node dissection for rectal cancer: A case report and literature review. Asian J Endosc Surg 2020; 13:578-581. [PMID: 32180365 DOI: 10.1111/ases.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
Abstract
A 63-year-old man who underwent robot-assisted laparoscopic low anterior resection and right lateral lymph node dissection (LLND) for rectal cancer presented with right thigh pain, nausea, vomiting, and abdominal pain on postoperative day 17. CT revealed dilated small bowel in the pelvis, and a small bowel loop was detected outside the internal iliac artery branch. Emergent laparoscopic surgery revealed the migration of the small bowel into the space beneath the right obturator nerve. The herniated bowel was reduced, and the obturator nerve was sharply dissected from the herniated bowel and preserved. The hernial orifice was left unrepaired. Postoperative recovery was uneventful, and the right thigh pain disappeared. It is important to consider the possibility of internal herniation beneath the obturator nerve after minimally invasive lateral lymph node dissection for rectal cancer.
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Affiliation(s)
- Hiroaki Uehara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshiyuki Yamazaki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hitoshi Kameyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Iwaya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Yousuke Gohda
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Itaru Chinen
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Kubota
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Makoto Aoki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Kazuaki Kobayashi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Daisuke Sato
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Naoyuki Yokoyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Tetsuya Otani
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
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Jejunal obstruction due to rare internal hernia between skeletonized external iliac artery and vein as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy-case report and review of literature. Arch Gynecol Obstet 2020; 302:1075-1080. [PMID: 32767070 PMCID: PMC7524845 DOI: 10.1007/s00404-020-05724-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022]
Abstract
Background Internal herniation of small intestine in the lesser pelvis alongside iliac vasculature is a rare occurrence. Skeletonization of iliac vessels during pelvic lymph node dissection (LND), as part of surgical staging or treatment of patients with uterine, ovarian or urogenital cancer, is a strict prerequisite for orifice formation. Case presentation A 68-year-old woman presented at the emergency department with complaints of constipation for the last 3 days and acute-onset abdominal pain, nausea and vomiting since few hours. She had a history of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and para-aortic and pelvic LND 7 years ago. A distended abdomen with diffuse tenderness on palpation was noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated hernia underneath an elongated right external iliac artery. During an emergency exploratory laparotomy, the incarcerated bowel was reduced and the hernial orifice closed with a running suture. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day. Discussion This rare internal hernia can manifest with non-specific symptoms of small bowel obstruction at any given point after index surgery, sometimes even after several years free of complaints. Contrast-enhanced computed tomography is the method of choice for fast and reliable diagnosis and helps in planning the necessary emergency laparotomy. Conclusion This life-threatening complication adds to the current controversy of pelvic and para-aortic lymphadenectomy in patients with endometrial cancer. Primary closure of peritoneal defects should be considered to potentially prevent internal hernias, especially when elongated iliac vessels are present. Electronic supplementary material The online version of this article (10.1007/s00404-020-05724-x) contains supplementary material, which is available to authorized users.
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Kanno T, Otsuka K, Takahashi T, Somiya S, Ito K, Higashi Y, Yamada H. Strangulated Internal Hernia Beneath the Obturator Nerve After Laparoscopic Radical Cystectomy With Extended Pelvic Lymph Node Dissection. Urology 2020; 145:11-12. [PMID: 32735980 DOI: 10.1016/j.urology.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
Internal hernia beneath the vascular structures after pelvic lymphadenectomy is a rare condition. Herein, we report a case of a strangulated internal hernia beneath the obturator nerve 38 months after laparoscopic radical cystectomy with extended pelvic lymphadenectomy. Computed tomography revealed dilated small bowels and a closed loop in the pelvis. The emergency laparotomy was performed, and a strangulated internal hernia beneath the obturator nerve was observed. It is necessary to consider the possibility of internal hernia beneath the vascular structure, including the obturator nerve, after the pelvic lymph lymphadenectomy, particularly via a minimally invasive approach.
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Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.
| | - Kazuo Otsuka
- Department of Surgery, Ijinkai Takeda General Hospital, Kyoto, Japan
| | | | - Shinya Somiya
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
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12
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Internal hernia beneath the left external iliac artery after robotic-assisted laparoscopic prostatectomy with extended pelvic lymph node dissection: a case report. Surg Case Rep 2019; 5:49. [PMID: 30923950 PMCID: PMC6439070 DOI: 10.1186/s40792-019-0609-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/19/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Formation of an internal hernia beneath a skeletonized pelvic vessel after pelvic lymph node dissection is extremely rare. We report a case of an internal hernia formation beneath the left external iliac artery after a robotic-assisted laparoscopic prostatectomy with extended pelvic lymph node dissection. CASE PRESENTATION A 72-year-old man visited our hospital complaining of severe lower abdominal pain. On physical examinations, his abdomen was distended and tympanitic with rebound tenderness and muscular defense. Abdominal non-enhanced computed tomography showed a small bowel obstruction with marked ascites. A coronal non-enhanced computed tomography image revealed thickened loops of small bowel with surrounding mesenteric edema in the left lower quadrant. Enhanced computed tomography was not performed because we decided to perform urgent surgery with a diagnosis of strangulated small bowel obstruction based on physical examination and the computed tomography findings. The patient underwent urgent laparotomy at which time bloody ascites was seen in the peritoneal cavity. The ileum, which was approximately 60 cm proximal to the ileocecal junction, formed a closed loop beneath the left external iliac artery. The incarcerated ileum, 120 cm in length, appeared non-viable with a color change of the ileum to black. We therefore resected the strangulated ileum for a length of 120 cm and performed a functional end-to-end anastomosis. The orifice beneath the left external iliac artery was about 4 cm in diameter. We did not close the orifice because of the risk of injuring the left iliac artery. The postoperative course was uneventful, and the patient was discharged from our hospital 10 days after surgery. Presently, the patient is doing well 5 months after surgery without recurrent disease. CONCLUSION We report an extremely rare case of internal hernia formation beneath the left external iliac artery after a robotic-assisted laparoscopic prostatectomy with extended pelvic lymphadenectomy. Awareness of such complication and early surgical treatment are important when treating patients with this rare occurrence.
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