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Titel: 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
VerfasserIn: Frenzel, Felix
Hollaender, Sebastian
Fries, Peter
Stroeder, Russalina
Stroeder, Jonas
Sprache: Englisch
Titel: Archives of Gynecology and Obstetrics
Bandnummer: 302
Heft: 5
Seiten: 1075–1080
Verlag/Plattform: Springer Nature
Erscheinungsjahr: 2020
Freie Schlagwörter: Internal hernia
Lymphadenectomy
Small bowel obstruction
Iliac vessels
Case report
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
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 orifce 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 difuse 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 orifce closed with a running suture. The patient had an uneventful postoperative period and was discharged on the ffth postoperative day. Discussion This rare internal hernia can manifest with non-specifc 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.
DOI der Erstveröffentlichung: 10.1007/s00404-020-05724-x
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-337110
hdl:20.500.11880/31029
http://dx.doi.org/10.22028/D291-33711
ISSN: 1432-0711
0932-0067
Datum des Eintrags: 31-Mär-2021
Bezeichnung des in Beziehung stehenden Objekts: Electronic supplementary material
In Beziehung stehendes Objekt: https://link.springer.com/article/10.1007/s00404-020-05724-x#Sec6
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Radiologie
Professur: M - Keiner Professur zugeordnet
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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