Successful Surgical Intervention of Strangulated Ileus with a Simple Cut of the External Iliac Vein without Vein Reconstruction

Hishikawa, Takanori; Oura, Shoji; Tomita, Mitsuhiro

doi:10.1159/000519198

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…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 ].…”

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%

“…The median time to onset from PL was 6 months, but its distribution was from 2 to 108 months, underscoring the point that PL-related SBO can occur anytime in patients with a history of PL. Three of four cases in which the incarcerated small bowel was preserved were of laparoscopic techniques [ 17 , 19 , 22 , 23 ], whereas open surgeries were performed in 13 of 15 cases in which the incarcerated small bowel was removed, including five cases converted from laparoscopic surgeries. Those findings might reflect the difficulty, in many cases, of providing the patients with an accurate diagnosis rapidly.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2022

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

et al. 2022

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“…On reduction of ischemic small bowel hernia, Dumont and Wexels [ 10 ] and Zhang et al [ 19 ] found the small bowel to be viable after warming it, so a resection was not done. Similarly, Hishikawa et al [ 18 ] and Chaconas et al [ 23 ] did not have to resect the small bowel as it was not ischemic. The mean hospital length of stay was 12.7 days for the 13 articles that reported it.…”

Section: Reviewmentioning

confidence: 99%

“…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. The second most common approach was to close the hernia defect with peritoneal flaps [ 6 , 12 , 21 ] and suture close [ 17 , 19 , 23 ].…”

Section: Reviewmentioning

confidence: 99%

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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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

Fujiwara,

Yano,

Matsumoto

et al. 2024

surg case rep

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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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Successful Surgical Intervention of Strangulated Ileus with a Simple Cut of the External Iliac Vein without Vein Reconstruction

Cited by 3 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 Herniation of Small Bowel Underneath Iliac Vascular Axis After Pelvic Surgery: A Systematic Review

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

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