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

Uehara, Hiroaki; Yamazaki, Toshiyuki; Kameyama, Hitoshi; Iwaya, Akira; Gohda, Yousuke; Chinen, Itaru; Kubota, Akira; Aoki, Makoto; Kobayashi, Kazuo; Sato, Daisuke; Yokoyama, Naoyuki; Kuwabara, Shirou; Otani, Tetsuya

doi:10.1111/ases.12795

Cited by 8 publications

(9 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other than our cases, only three published reports describe PL-related SBO caused by a band constructed by the obturator nerve [ 19 , 28 , 30 ]. In these cases, the authors preserved the obturator nerve, leaving the hernia orifice unrepaired.…”

Section: Discussionmentioning

confidence: 69%

“…It is particularly interesting that about half of reports have originated from the gynecologic field, in which all the initial gynecologic surgeries were done laparoscopically [ 13 , 17 – 23 ]; moreover, approximately one-third of those reports were from the urologic area, in which the primary operations, except for the first case reported, were laparoscopic or robot-assisted surgeries [ 12 , 24 – 28 ]. Recently, two reports described three cases after rectal cancer surgeries [ 29 , 30 ]. In general, PL performed in gynecologic and urological fields can dissect lymph nodes around an external iliac artery or common iliac artery [ 1 , 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to past papers, vessels or nerves constructing the internal hernia orifice were right common iliac artery (3 cases) [ 12 , 18 , 24 ], left external iliac artery and/or vein (4 cases) [ 17 , 22 , 25 , 27 ], right external iliac artery and/or vein (4 cases) [ 13 , 20 , 23 , 26 ], right superior vesical artery (3 cases) [ 21 , 29 ] and right umbilical artery and/or obturator nerve (5 cases) [ 19 , 28 , 30 ]. In fact, PL-related SBO is more common on the right side than on the left side (Table 1 ), which might be attributable to the fact that the left side is covered with the sigmoid colon.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Small bowel obstruction caused by an internal hernia beneath vascular structures after pelvic lymphadenectomy is rare; only three cases have been reported 3,4 . Hernial defects may develop when the lymphatic tissue around the iliac vessels and obturator nerve are removed; however, this is a rare complication of rectal cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Internal hernia caused by exposed structures after laparoscopic lateral lymph node dissection for rectal cancer: A case report

Sakamoto¹,

Inada²,

Kuroda³

et al. 2023

Asian J Endoscop Surgery

View full text Add to dashboard Cite

show abstract

“…Generally, internal hernia of the small intestine is difficult to make a diagnosis. However, the diagnosis of internal hernia beneath the EIA by a preoperative contrast-enhanced CT scan helped to detect the correlation between small bowel and vessels [ 5 ]. In the present case, contrast-enhanced CT also provided important auxiliary information for operation in time to avoid bowel resection.…”

Section: Discussionmentioning

confidence: 99%

A strangulated internal hernia beneath the left external iliac artery after radical hysterectomy with laparoscopic pelvic lymphadenectomy: a case report and literature review

Zhang

et al. 2021

BMC Surg

View full text Add to dashboard Cite

Background Ileum obstruction due to internal hernia beneath external iliac artery after pelvic lymph node dissection (PLND) is extremely rare. We reported a case of acute strangulated internal hernia between the left external iliac artery and psoas major as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy. Case presentation A 46-year-old woman, who with histories of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and PLND 9 years ago for the cervical malignant tumor, open appendectomy 18 years ago, visited our hospital complaining of aggravated left lower abdominal pain, bloating, nausea and vomiting from few hours ago. Left abdomen distention, tympanitic with rebound tenderness and muscular tension was detected during physical examinations. Accompanying with elevated inflammatory markers and mild intestinal dilatation showed in lab results and contrast-enhanced computed tomography (CT) respectively. After carefully reading the CT images, a small bowel was found between the left external iliac artery (EIA) and the psoas major, combined with the patient's surgical history, we suspected it might be internal hernia. Eventually, the emergency laparoscopic laparotomy confirmed our conjecture, the gap between the iliac vessels and the psoas major was closed with an absorbable suture, the patient was discharged on the fourth postoperative day. Conclusion Primary closure of peritoneal fissue maybe an effective measure to potentially prevent internal hernia. The choice of surgical approach for pelvic tumors still needs further exploration but faster diagnosis and immediate laparotomy might promise a better prognosis.

show abstract

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

Cited by 8 publications

References 10 publications

Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports

Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports

Internal hernia caused by exposed structures after laparoscopic lateral lymph node dissection for rectal cancer: A case report

A strangulated internal hernia beneath the left external iliac artery after radical hysterectomy with laparoscopic pelvic lymphadenectomy: a case report and literature review

Contact Info

Product

Resources

About