A rare complication of Aortobifemoral bypass operation: Internal Herniation: Report of a case

Abstract

Intestinal brids are most common cause of postoperative ileus although there are various cause of ileus after abdominal operation. On the other hand internal herniation is a rare cause of ileus after abdominal operations. Diagnosis of this hernias are important because of strangulation and necrosis of its content due to circulatory disturbance. In this case report, we publish a patient with ileus due to a greft which has been used in a previous abdominal surgery for abdominal aort aneurysm.Key Words: Aortobifemoral bypass; internal herniation/complication.Karın operasyonları sonrası çeşitli nedenler dolayısıyla olmakla beraber, en sık intestinal yapışıklıklara bağlı mekanik intestinal tıkanıklık (MİT) görülebilmektedir. İnternal herniasyonlar ise karın operasyonları sonrası nadir bir MİT nedenidir. Bu hernilerde içeriğin boğulma ve nekroza kadar giden dolaşım bozukluğu nedeniyle doğru tanı konabilmesi önemlidir. Bu yazıda, karın aort anevrizma ameliyatı sonrası kullanılan greftin neden olduğu internal herniasyon sonucu oluşan MİT sunuldu. Internal herniation is a rare cause of intestinal occlusion. Internal herniation, either congenital or acquired, is responsible for 0.6-5.8% of all intestinal occlusions. [1] Abdominal aortic aneurism (AAA) is a frequently encountered pathology with a prevalence of 1-4% of the entire population and is observed in 5-9% of men older than 65 years.[2] Currently, treatment for AAA is the interposition of vascular prosthesis by surgically reaching the aneurysmatic section of the aorta specifically through the abdomen.[2] Gastrointestinal complications such as ischemic colitis, mechanical ileus and aortoduodenal fistula incidence is 20% in the post-operative period and 16% to 67% of these complications may be mortal. [3] We aimed to present a case that presented to our emergency surgical clinic one week after the aortobifemoral by-pass surgery with a complaint of the ileus. CASE REPORTA 56-year-old male patient presented to our emergency unit with complaints of abdominal pain and inability to pass gas or move his bowels that was ongoing for 2 days. A midline incision was identified during his abdominal examination, and he explained that he had an operation for AAA in another healthcare institution one week prior. Abdominal distention was present and the patient described malodorous vomiting once before his presentation to the emergency unit. Bowel sounds were hypoactive. There was tenderness in the four abdominal quadrants. Formed stool was identified in the rectal touch. Air-fluid levels were observed on X-ray. Fecaloid content came out from the case after placement of the catheter for decompression. The computed tomography (CT) was unremarkable for the ileus. The patient was urgently admitted for surgery due to deterioration of his general condition and acute abdominal findings. Exploratory laparotomy revealed