Small Bowel Obstruction After Laparoscopic Radical Hysterectomy Caused by Strangulated Internal Herniation Through a Defect Between the Right Iliac Vein and Ureter：A Case Report

Abstract

Objective: We describe a rare case of strangulated internal hernia occurring through the slit between the right iliac vein and ureter after laparoscopic radical hysterectomy. Case and Methods: A 43-year-old woman who had undergone laparoscopic radical hysterectomy and pelvic lymphadenectomy was admitted to our hospital complaining of upper abdominal pain. Abdominal contrast-enhanced computed tomography showed evidence of strangulated intestinal herniation. Emergency surgery was performed, which revealed a strangulated small bowel loop through the slit between the right iliac vein and the ureter. While we could not directly visualize the strangulated hernia, we could palpate a band corresponding to the strangulated bowel loop and released the strangulated small bowel by hand manipulation. A slit between the right iliac vein and ureter was found as the orifice for the internal herniation, which was closed it by simple suture to prevent recurrence. Results： There were no postoperative complications, and the patient was discharged on postoperative day 9. Conclusions：We considered that the slit through which the herniation occurred was an iatrogenic slit caused during pelvic lymphadenectomy, which has rarely been reported before. In cases of strangulated intestinal obstruction in the postoperative pelvic cavity, bands should be incised with care to ensure safety, because they might be closely related to blood vessels and/or the ureter.