Abstract
The patient was a 68-year-old man who underwent laparoscopic super-low anterior resection with bilateral lymph node dissection for lower rectal cancer. The histopathological diagnosis was pT2N0M0, pStage I. Postoperatively, paralytic ileus occurred, but the patient was discharged after conservative treatment. Three months after surgery, the patient presented to our hospital as an emergency for a complaint of severe right inguinal pain. An abdominal contrast-enhanced CT scan revealed a closed loop of the small intestine on the right side of the pelvis, and an emergency operation was performed under a diagnosis of strangulated bowel obstruction. Intraoperative findings revealed that the small intestine had strayed into the gap between the right upper bladder artery and the right internal iliac artery, which had been exposed by lateral lymph node dissection. The small intestine was entrapped and necrotic, but the entrapment was easily released. After confirming that the left upper bladder and right lower bladder arteries were preserved, we decided to ligate and dissect the right upper bladder artery to prevent recurrence of the entrapment. Partial resection of the small intestine, including the necrotic intestine, and anastomotic reconstruction were then performed. A histopathological examination showed necrosis of the entire intestinal wall. We believe that this is the first reported case of strangulated bowel obstruction caused by exposed blood vessels after laparoscopic super-low anterior resection with lateral lymph node dissection for rectal cancer.
