Ninomiya Shigeo, Amano Shota, Ogawa Tadashi, Ueda Yoshitake, Shiraishi Norio, Inomata Masafumi, Shimoda Katsuhiro
Department of Surgery, Cosmos Hospital, 1131-1 Tomuro, Usuki, 875-0051, Japan.
Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan.
Surg Case Rep. 2019 Mar 28;5(1):49. doi: 10.1186/s40792-019-0609-6.
Formation of an internal hernia beneath a skeletonized pelvic vessel after pelvic lymph node dissection is extremely rare. We report a case of an internal hernia formation beneath the left external iliac artery after a robotic-assisted laparoscopic prostatectomy with extended pelvic lymph node dissection.
A 72-year-old man visited our hospital complaining of severe lower abdominal pain. On physical examinations, his abdomen was distended and tympanitic with rebound tenderness and muscular defense. Abdominal non-enhanced computed tomography showed a small bowel obstruction with marked ascites. A coronal non-enhanced computed tomography image revealed thickened loops of small bowel with surrounding mesenteric edema in the left lower quadrant. Enhanced computed tomography was not performed because we decided to perform urgent surgery with a diagnosis of strangulated small bowel obstruction based on physical examination and the computed tomography findings. The patient underwent urgent laparotomy at which time bloody ascites was seen in the peritoneal cavity. The ileum, which was approximately 60 cm proximal to the ileocecal junction, formed a closed loop beneath the left external iliac artery. The incarcerated ileum, 120 cm in length, appeared non-viable with a color change of the ileum to black. We therefore resected the strangulated ileum for a length of 120 cm and performed a functional end-to-end anastomosis. The orifice beneath the left external iliac artery was about 4 cm in diameter. We did not close the orifice because of the risk of injuring the left iliac artery. The postoperative course was uneventful, and the patient was discharged from our hospital 10 days after surgery. Presently, the patient is doing well 5 months after surgery without recurrent disease.
We report an extremely rare case of internal hernia formation beneath the left external iliac artery after a robotic-assisted laparoscopic prostatectomy with extended pelvic lymphadenectomy. Awareness of such complication and early surgical treatment are important when treating patients with this rare occurrence.
盆腔淋巴结清扫术后，在骨骼化的盆腔血管下方形成内疝极为罕见。我们报告一例在机器人辅助腹腔镜前列腺切除术联合扩大盆腔淋巴结清扫术后，左髂外动脉下方形成内疝的病例。
一名72岁男性因严重下腹痛前来我院就诊。体格检查时，其腹部膨隆，呈鼓音，有反跳痛和肌紧张。腹部非增强计算机断层扫描显示小肠梗阻并伴有大量腹水。冠状面非增强计算机断层扫描图像显示左下腹小肠肠袢增厚，周围肠系膜水肿。由于根据体格检查和计算机断层扫描结果诊断为绞窄性小肠梗阻，决定进行急诊手术，因此未进行增强计算机断层扫描。患者接受了急诊剖腹手术，此时在腹腔内可见血性腹水。距回盲部约60cm的回肠在左髂外动脉下方形成一个闭合环。被嵌顿的回肠长120cm，颜色变黑，看起来已无生机。因此，我们切除了120cm长的绞窄性回肠，并进行了功能性端端吻合。左髂外动脉下方的孔口直径约为4cm。由于有损伤左髂动脉的风险，我们未关闭该孔口。术后过程顺利，患者术后10天出院。目前，患者术后5个月情况良好，无疾病复发。
我们报告了一例在机器人辅助腹腔镜前列腺切除术联合扩大盆腔淋巴结清扫术后，左髂外动脉下方形成内疝的极为罕见的病例。认识到这种并发症并进行早期手术治疗对于治疗这种罕见情况的患者很重要。
