Internal hernia beneath superior vesical artery after pelvic lymphadenectomy for cervical cancer: a case report and lite
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CASE REPORT
Internal hernia beneath superior vesical artery after pelvic lymphadenectomy for cervical cancer: a case report and literature review Wen Ai, Zhihua Liang, Feng Li and Haihua Yu*
Abstract Background: The common complications of radical hysterectomy and pelvic lymphadenectomy usually include wound infection, hemorrhage or hematomas, lymphocele, uretheral injury, ileus and incisional hernias. However, internal hernia secondary to the orifice associated with the uncovered vessels after pelvic lymphadenectomy is very rare. Case presentation: We report a case of internal hernia with intestinal perforation beneath the superior vesical artery that occurred one month after laparoscopic pelvic lymphadenectomy for cervical cancer. A partial ileum resection was performed and the right superior vesical artery was transected to prevent recurrence of the internal hernia. Conclusions: Retroperitonealization after the pelvic lymphadenectomy should be considered in patients with tortuous, elongated arteries which could be causal lesions of an internal hernia. Keywords: Internal hernia, Perforation, Superior vesical artery, Laparoscopic pelvic lymphadenectomy Background Radical hysterectomy and lymphadenectomy is a standard procedure in the radical surgery for cervical cancer. The common complications of radical hysterectomy and pelvic lymphadenectomy usually include wound infection, hemorrhage or hematomas, lymphocele, uretheral injury, ileus and incisional hernias [1]. However, internal hernia secondary to the orifice associated with the skeletonized vessels is very rare. Here we first report a case of internal hernia beneath superior vesical artery after pelvic lymphadenectomy for cervical cancer and conduct a literature review.
*Correspondence: [email protected] The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong, China
Case presentation A 53-year-old woman underwent a laparoscopic radical hysterectomy, pelvic lymphadenectomy, para-aortic lymph node dissection and bilateral salpingo-oophorectomy for cervical cancer. In addition, a double J tube was placed in the left ureter for the sake of intraoperative urethral injury. The surgical pathology showed moderately differentiated squamous cell carcinoma and tumour metastasis was not found in the dissected 71 lymph nodes (Stage IB3). The postoperative hospital stay was uneventful and the patient was discharged 15 days after surgery. Two weeks later, she was admitted to our hospital again with a 5-day history of abdominal pain, vomiting, and the inability to pass gas or stools. Physical examination showed the abdominal distension, tenderness and hyperactive bowel sounds without rebound tenderness and muscular defense. Generally, the laboratory findings were
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