A Case of Strangulated Bowel Obstruction due to a Right External Iliac Artery Developed after Surgery for Prostatic Cancer

Abstract

A 75-year-old man who underwent robot-assisted prostatectomy for prostatic cancer 2 years previously presented to our emergency clinic because of the abrupt onset of right lower abdominal pain. An abdominal contrast-enhanced CT scan provided a diagnosis of strangulated bowel obstruction due to a right external iliac artery. Emergency laparotomy was thus performed. Intraoperative findings included that a small bowel had impacted in the interstice between the right external iliac artery which had exposed due to lymph node dissection at prostatectomy for prostatic cancer and the retroperitoneum. Manual reduction of the impacted bowel was difficult. So the impaction was reduced by collapsing the bowel while contents in the dilated and necrotized bowel were sucked up without injuring the right external iliac artery, and then we achieved partial small bowel resection. In order to prevent recurrence, the retroperitoneum was incised to cover the right external iliac artery. The patient's postoperative course was uneventful, and the patient was discharged from our hospital on the 11^th postoperative day. Few cases of strangulated bowel obstruction due to the external iliac artery have been reported. We present such a rare case with a review of the literature.