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Permekerlis A, Gemousakaki E, Tepelidis C, Fotiadis P. Internal Herniation Causing Double Obstruction of the Small Bowel and Urinary Tract: A Rare Case Presentation. Cureus 2024; 16:e65483. [PMID: 39188423 PMCID: PMC11346821 DOI: 10.7759/cureus.65483] [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: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
Small bowel obstruction is one of the most common urgent surgical conditions, caused by a variety of factors, with adhesions, malignancies, and hernias, internal and external, being the most common. Many types of internal hernias have been described in the literature; however, internal hernia caused by the ureter as a secondary complication of ureteroplasty is rare and only a few cases have been reported worldwide. This presentation discusses an interesting case of small bowel obstruction accompanied by obstruction of the urinary tract due to an internal hernia caused by the ureter. A 58-year-old female presented to the emergency department (ED) with acute pain in the abdominal and right lumbar region. Her surgical history includes hysterectomy, right ureter injury, and ureteroplasty performed 10 years ago. Clinical examination showed tenderness in the lower abdomen, positive Giordano's sign on the right, and metallic bowel sounds. A computer tomography scan revealed right-sided hydronephrosis, absence of excretion in the right urinary tract, and dilated loops of the small intestine. An exploratory laparoscopy revealed a small bowel loop strangulated by the ureter, followed by laparotomy, resection of a segment of the ileum, oblique anastomosis, and reimplantation of the right ureter. The patient was discharged eight days postoperatively without any complications. This case underscores the significance of surgical history in order to recognize even rarer causes of small bowel obstruction.
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Affiliation(s)
| | - Eirini Gemousakaki
- 2nd Surgical Department, 424 General Military Hospital, Thessaloniki, GRC
| | - Christos Tepelidis
- 2nd Surgical Department, 424 General Military Hospital, Thessaloniki, GRC
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Spazzapan M, Bullingham R, Nkwam NM, Ypsilantis E. Paraureteric space post-ureteric re-implantation: a rare cause of small bowel obstruction. BMJ Case Rep 2022; 15:e252356. [PMID: 36585052 PMCID: PMC9809218 DOI: 10.1136/bcr-2022-252356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A female patient in her 80s presented with a 2-day history of abdominal pain and absolute constipation, having previously undergone a robotic left distal ureterectomy with ureteric re-implantation. CT revealed a closed-loop small bowel obstruction with transition point adjacent to the left ureter and resultant upstream hydronephrosis. An emergency laparotomy revealed small bowel herniation into a paraureteric space created by her previous surgery and defined by the distal ureter medially, the common iliac vessels laterally and the mobilised bladder dome anteriorly. The viable small bowel was reduced, and the space was eliminated by omental flap transposition after omentoplasty. The patient made a full recovery. Preoperative diagnosis of such an unusual cause of internal herniation can be challenging. This very rarely reported case raises awareness of the condition and proposes a treatment strategy.
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Affiliation(s)
- Martina Spazzapan
- Princess Royal University Hospital, Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Roberta Bullingham
- Princess Royal University Hospital, Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Efthymios Ypsilantis
- Princess Royal University Hospital, Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
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Zhao P, Wang C, Mao K, Luo Z, Li Y, Zhou G, Tan H, Liu H, Mao Y, Ma H, Shang X, Liu B. Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor. Front Pediatr 2022; 10:966292. [PMID: 35989992 PMCID: PMC9386036 DOI: 10.3389/fped.2022.966292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor. MATERIALS AND METHODS Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups. RESULTS All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced. CONCLUSION Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.
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Affiliation(s)
- Peng Zhao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Cao Wang
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Kaiyi Mao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhen Luo
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yingbo Li
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangxu Zhou
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongyang Tan
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Liu
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yucheng Mao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Ma
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianhui Shang
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Bin Liu
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Lee MS, Shen M, Williams A, Kendrick D, Weizer A, Montgomery J. Retroureteral Small Bowel Herniation Resulting in Bowel Obstruction Following Robotic Cystectomy With Extracorporeal Ileal Conduit. Urology 2020; 147:3-6. [PMID: 32603744 DOI: 10.1016/j.urology.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Matthew S Lee
- Department of Urologic Oncology, University of Michigan, Ann Arbor, MI.
| | - Mary Shen
- Department of General Surgery, University of Michigan, Ann Abor, MI
| | - Aaron Williams
- Department of General Surgery, University of Michigan, Ann Abor, MI
| | - Daniel Kendrick
- Department of General Surgery, University of Michigan, Ann Abor, MI
| | - Alon Weizer
- Department of Urologic Oncology, University of Michigan, Ann Arbor, MI
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