Internal hernia and gangrenous intestine. A rare complication of a femoral--femoral bypass graft.

An unusual case of an internal hernia related to a retropubic femoral-femoral bypass graft is presented. An orifice between the left and right inguinal ligaments and a protruding intraperitoneal portion of the prosthetic graft material resulted in herniation and strangulation of a portion of the small intestine. Technical factors (graft redundancy or misplacement) and natural factors (pulsatile erosion or age elongation) may be implicated. The potential for this complication exists in all grafts currently placed. The subcutaneous location appears to be a better technique.