Jejunal obstruction due to rare internal hernia between skeletonized external iliac artery and vein as late complication
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REVIEW
Jejunal obstruction due to rare internal hernia between skeletonized external iliac artery and vein as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy—case report and review of literature Felix Frenzel1 · Sebastian Hollaender2 · Peter Fries1 · Russalina Stroeder3 · Jonas Stroeder1 Received: 20 February 2020 / Accepted: 28 July 2020 © The Author(s) 2020
Abstract Background Internal herniation of small intestine in the lesser pelvis alongside iliac vasculature is a rare occurrence. Skeletonization of iliac vessels during pelvic lymph node dissection (LND), as part of surgical staging or treatment of patients with uterine, ovarian or urogenital cancer, is a strict prerequisite for orifice formation. Case presentation A 68-year-old woman presented at the emergency department with complaints of constipation for the last 3 days and acute-onset abdominal pain, nausea and vomiting since few hours. She had a history of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and para-aortic and pelvic LND 7 years ago. A distended abdomen with diffuse tenderness on palpation was noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated hernia underneath an elongated right external iliac artery. During an emergency exploratory laparotomy, the incarcerated bowel was reduced and the hernial orifice closed with a running suture. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day. Discussion This rare internal hernia can manifest with non-specific symptoms of small bowel obstruction at any given point after index surgery, sometimes even after several years free of complaints. Contrast-enhanced computed tomography is the method of choice for fast and reliable diagnosis and helps in planning the necessary emergency laparotomy. Conclusion This life-threatening complication adds to the current controversy of pelvic and para-aortic lymphadenectomy in patients with endometrial cancer. Primary closure of peritoneal defects should be considered to potentially prevent internal hernias, especially when elongated iliac vessels are present. Keywords Internal hernia · Lymphadenectomy · Small bowel obstruction · Iliac vessels · Case report
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00404-020-05724-x) contains supplementary material, which is available to authorized users. * Felix Frenzel [email protected] 1
Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Saar, Germany
2
Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Center, 66421 Homburg, Saar, Germany
3
Clinic for Gynecology and Obstetrics, Saarland University Medical Center, 66421 Homburg , Saar, Germany
Internal hernias originate from passage of intestinal structures, usually small intestine, through congenital or acquired apertures within the boundaries of the peritoneal cavity. Clinical complaints resul
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