A Case of Strangulated Bowel Obstruction with a Thrombus in the External Iliac Vein after Modified Radical Hysterectomy

Abstract

A 56-year-old woman, who had undergone a modified radical hysterectomy with pelvic lymphadenectomy for uterine cancer one year ago was brought to our hospital, experiencing pain in the abdominal region and right thigh and vomiting. Enhanced computed tomography showed a strangulated loop of the small bowel below the right external iliac artery and vein, with an intravenous thrombus, for which emergency open surgery was performed. Intraoperative findings indicated that the terminal ileum was impacted and necrotic, and the right external iliac vein was constricted and stenotic. The impacted bowel was reduced, and ileocolic resection was performed, including 80 cm of the necrotic jejunum and terminal ileum. Intraoperative ultrasonography showed a thrombus in the right external iliac vein that was removed via an incision. On the 10^th postoperative day, another thrombus was found in the right external iliac vein. Symptoms of the patient improved after heparin and edoxaban administration, and she was discharged from the hospital on the 25^th postoperative day. In cases of intestinal obstruction with previous pelvic lymphadenectomy, strangulated intestinal obstruction due to the external iliac artery and the possibility of thrombosis should be considered.