Ileal Obstruction Secondary to Internal Hernia Under the External Iliac Artery: A Case Report and Literature Review

Chowdary, Prashanth Basappa; Wright, Christopher

doi:10.7759/cureus.28107

Cited by 4 publications

(8 citation statements)

References 9 publications

(23 reference statements)

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“…Although controversial due to the chances of recurrence, the defect was not closed by three authors due to fear of vascular injury [ 10 , 15 - 16 ]. Chowdary and Wright [ 20 ] left the defect open due to concerns regarding bacterial contamination of the closing material. Hishikawa et al [ 18 ] chose not to close the defect because it divided the external iliac vein itself, underneath which the bowel was herniating.…”

Section: Reviewmentioning

confidence: 99%

“…Hishikawa et al [ 18 ] chose not to close the defect because it divided the external iliac vein itself, underneath which the bowel was herniating. The second most common approach was to close the hernia defect with peritoneal flaps [ 6 , 12 , 21 ] and suture close [ 17 , 19 , 23 ]. Absorbable suture material was reported in two of the reports.…”

Section: Reviewmentioning

confidence: 99%

“…The authors’ personal experience with internal herniation of the small bowel underneath the external iliac artery was reported in the case report from Khalid et al [ 6 ]. In this report, it was highlighted that intraoperatively, the artery could appear similar to a band which could lead to the iatrogenic division of a major vessel.…”

Section: Reviewmentioning

confidence: 99%

“…The authors’ personal experience with internal hernia is reported in Khalid et al [ 6 ]. We found a case of an internal hernia underneath the external iliac artery.…”

Section: Introductionmentioning

confidence: 99%

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Internal Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review

Khalid¹,

Ashraf²,

Salman³

et al. 2023

Cureus

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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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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

“…The authors’ personal experience with internal hernia is reported in Khalid et al [ 6 ]. We found a case of an internal hernia underneath the external iliac artery.…”

Section: Introductionmentioning

confidence: 99%

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Internal Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review

Khalid¹,

Ashraf²,

Salman³

et al. 2023

Cureus

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“…Rare causes of small bowel obstructions should be maintained on the differential diagnosis, especially while reviewing CT imaging, and taking a thorough surgical history. As all the documented obstructions in the literature caused by an intraperitoneal external iliac artery, totaling six cases, 3 have one thing in common: a pelvic cancer pathology necessitating pelvic lymphadenectomy. Given the rare occurrence and generally late presentation of these unique obstructions, it is unlikely that a preventive strategy would be employed by the oncologic surgeons which are often performed minimally invasively at the index procedure.…”

mentioning

confidence: 99%

High Grade Intestinal Obstruction From Internal Hernia Beneath an Intraperitoneal External Iliac Artery

Chaconas,

Moncada,

Pepe

et al. 2023

The American Surgeon™

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Acute small bowel obstruction (SBO) is a common cause of emergency department visits in the United States, and it accounts for approximately 20% of emergency surgical operations.1 Its etiology is divided into intrinsic luminal obstruction or extrinsic compression of the bowel.2 Among the causes of SBO, by far the most common is intraperitoneal adhesions due to previous abdominal surgeries, which comprises about 60-70% of the cases.2 The abdominal cavity is subdivided into the peritoneal cavity and the retroperitoneal cavity; the division is marked by a thin covering of parietal peritoneum that encases all the intraperitoneal structures. Here, we present a rare case of an acute small bowel obstruction secondary to exposure of the retroperitoneal external iliac artery from a surgical procedure 20 years prior to presentation.

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Internal hernia a preoperative diagnostic challenge in virgin abdomen: case report

Montero-Puga,

Pat-Cruz,

Arredondo

2024

Int Surg J

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Internal hernias are classified in congenital or acquired. Congenital arises from abnormalities during embryonic development, whereas acquired result from trauma, surgical procedures, or another. Gastric surgical procedures can increase susceptibility to internal hernias. A 85-year-old female, denies previous surgeries. Went to the emergency department due to vomiting, adding colicky abdominal pain. Was discharged with a diagnosis of acute gastroenteritis. Came back 12 hours after discharge due to mesogastric pain accompanied by general malaise, abdominal distention and hyporexia, reporting a lack of evacuation. She was algid, pale, abdomen globose, distended, tympanic colonic frame, peristalsis increased. An evaluation was requested from general surgery for probable appendicitis in the elderly vs. secondary ileus. Went to operation room, finding an internal hernia. Transomental herniations are rare conditions. An abnormal omental opening can be either acquired following abdominal surgery, trauma, inflammatory conditions, low body mass index (BMI) and be associated with a long mesentery, intestinal malrotation, or abnormal peritoneal attachments. Although internal hernias are extremely rare (between 1 and 4% of acute or intermittent intestinal obstructions) it is essential not to miss this diagnosis, even in patient whit no previous surgeries. Management of omental hernias are critical as the postoperative mortality rate is over 30% and even 50% if strangulation is present. The lack of current literature on this rare condition, particularly for lesser omental hernias (because can present with nonspecific signs and symptoms) makes diagnosis and management difficult.

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Ileal Obstruction Secondary to Internal Hernia Under the External Iliac Artery: A Case Report and Literature Review

Cited by 4 publications

References 9 publications

Internal Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review

Internal Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review

High Grade Intestinal Obstruction From Internal Hernia Beneath an Intraperitoneal External Iliac Artery

Internal hernia a preoperative diagnostic challenge in virgin abdomen: case report

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