Iatrogenic Internal Hernia Involving the Iliac Artery

Abstract

Four months postradical lymphadenectomy and pelvic irradiation for Stage I teratocarcinoma of the testis, a patient was found to have an internal strangulated herniation of small bowel beneath the right iliac artery. The operative management is discussed, and the literature is reviewed concerning the etiology of small bowel obstruction in postoperative, irradiated patients and the techniques of peritoneal closure.

A Rare Complication After Laparoscopic Lateral Lymph Node Dissection for Rectal Cancer: Two Case Reports of Internal Hernia Below the Superior Vesical Artery

“…Hiki et al reported significantly more postoperative intra-abdominal adhesions in open surgery than in laparoscopic surgery 8) . Typical compli- We searched the PubMed database using the key words "internal hernia," "pelvis (or pelvic)," and "artery" and found six case reports of internal hernia underneath the pelvic blood vessel after pelvic LLND (Table 1) [9][10][11][12][13][14] . In these six reports, three cases occurred after urological surgery and three after gynecological surgery.…”

Internal hernia beneath the obturator nerve after robot‐assisted lateral lymph node dissection for rectal cancer: A case report and literature review

“…In 1978, the first case of bowel obstruction after open pelvic lymphadenectomy for testicular teratoma was reported. 1 Since then, four more cases have been reported in patients who underwent laparoscopic pelvic lymphadenectomy for gynecological malignancies, [2][3][4]7 and four other cases have been reported in patients who underwent robot-assisted pelvic lymphadenectomy for urological malignancies. 5,6,8,9 To our knowledge, there is no evidence on increased internal hernia after laparoscopic surgery compared with open surgery.…”

“…7 Also, cases of the common or external iliac artery causing bowel herniation have been reported. [1][2][3][4][5][6]8,9 Pelvic lymphadenectomy for any cancer creates iatrogenic defects and poses a risk of internal hernia.…”

“…Of the previously reported patients, eight (88.9%) required bowel resection to treat internal hernia. 1,2,[4][5][6][7][8][9] To reduce the risk of bowel resection, rapid diagnosis and emergent surgical intervention are essential for treating patients with internal hernia after pelvic lymphadenectomy. In the present case, the symptoms were only temporarily improved with nonsurgical treatments; therefore, a second surgery was performed 1 month after the appearance of ileal symptoms.…”

“…In recent years, cases of internal hernia, a rare complication after pelvic lymphadenectomy, have been reported. [1][2][3][4][5][6][7][8][9] Internal herniation of the small bowel beneath the obturator nerve after pelvic lymphadenectomy is extremely rare. Here, we report a case of laparoscopic reduction of bowel herniation located beneath the obturator nerve after robot-assisted laparoscopic LLND for rectal cancer.…”