A Case of Intestinal Obstruction due to Strangulation by the Left External Iliac Artery Exposed by Robot-assisted Total Prostatectomy

Abstract

A 75-year-old man had undergone robot-assisted total prostatectomy and pelvic lymph node dissection four years earlier. He was brought to our hospital by ambulance with a chief complaint of left lower abdominal pain. Strangulated intestinal obstruction caused by the left external iliac artery was diagnosed by abdominal contrast-enhanced computed tomography, and emergency surgery was performed. On laparoscopy, it was seen that the small intestine had become trapped in the gap between the exposed left external iliac artery and the abdominal wall. Repositioning was attempted but proved unsuccessful, and the procedure was converted to open surgery. A 30-cm length of the small intestine was necrotic, so ileocecal resection was conducted, and the intestine was reconstructed with a functional end-to-end anastomosis. The patient's postoperative course was uneventful, and he was discharged on postoperative Day 9. Pelvic lymph node dissection is widely used for gynecological cancers and rectal cancer, as well as for urological disorders, and postoperative adhesions are decreased by laparoscopic surgery and robot-assisted surgery. Cases of strangulated ileus caused by residual freed tissue, as in the present patient, are likely to increase in future, and in patients with a history of pelvic lymph node dissection, the possibility that the cord-like structure causing the strangulation may be a blood vessel must be borne in mind.