A Case of Strangulated Bowel Obstruction Presented with Right Leg Pain

Abstract

A 39-year-old woman, who had undergone extended hysterectomy with pelvic lymphadenectomy and radiation therapy for cervical cancer 3 years before, presented with the acute onset of right leg pain. A computed tomography with contrast demonstrated a closed loop of the ileum highly suspected of strangulated bowel obstruction. She scarcely had abdominal symptoms, but we employed surgery due to her history of undergoing surgery. Emergent laparotomy revealed the ileum herniated into the space between the skeletonized right external and right internal iliac vessels. We reduced the internal herniation smoothly, without any ischemic signs of the ileum. The leg pain completely disappeared immediately after the operation. The postoperative course was uneventful, and she was discharged on the 8th postoperative day. A few cases of strangulated bowel obstruction with a history of pelvic lymphadenectomy have been reported, and skeletonized vessels and ureter can cause various patterns of symptoms. Our patient presented with severe leg pain, and the pain was explained by the compression of the obturator nerve due to herniated ileal dilation. When a patient has strangulated bowel obstruction with a history of pelvic lymphadenectomy, atypical complaints like in this case must be considered.