Author:
Fujiwara Ryota,Yano Masaaki,Matsumoto Makoto,Higashihara Tomoaki,Tsudaka Shimpei,Hashida Shinsuke,Ichihara Shuji,Otani Hiroki
Abstract
Abstract
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.
Publisher
Springer Science and Business Media LLC
Reference30 articles.
1. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. Am J Roentgenol. 2006;186(3):703–17.
2. Yoshihara M, Kajiyama H, Tamauchi S, Iyoshi S, Yokoi A, Suzuki S, et al. Prognostic impact of pelvic and para-aortic lymphadenectomy on clinically-apparent stage I primary mucinous epithelial ovarian carcinoma: a multi-institutional study with propensity score-weighted analysis. Jpn J Clin Oncol. 2020;50(2):145–51.
3. Aslan K, Meydanli MM, Oz M, Tohma YA, Haberal A, Ayhan A. The prognostic value of lymph node ratio in stage IIIC cervical cancer patients triaged to primary treatment by radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy. J Gynecol Oncol. 2020;31(1): e1.
4. Morice P, Castaigne D, Pautier P, Rey A, Haie-Meder C, Leblanc M, et al. Interest of pelvic and paraaortic lymphadenectomy in patients with stage IB and II cervical carcinoma. Gynecol Oncol. 1999;73(1):106–10.
5. García-Perdomo HA, Correa-Ochoa JJ, Contreras-García R, Daneshmand S. Effectiveness of extended pelvic lymphadenectomy in the survival of prostate cancer: a systematic review and meta-analysis. Cent Eur J Urol. 2018;71(3):262–9.