Case report of laparoscopic reduction of retro-ureter incarcerated small bowel obstruction

Abstract

Rationale: Various types of internal hernias have been reported including paraduodenal, intersigmoidal, pericecal, foramen of Winslow, as well as transmesenteric and retroanastomotic hernias. However, small bowel obstruction secondary to an internal hernia caused by the ureter is rare, and only a few cases have been reported worldwide. We report a case of small bowel herniation caused by the ureter in a woman who underwent radical hysterectomy for cervical cancer. Patient concerns: A 53-year-old woman presented with acute abdominal pain and vomiting and reported a history of radical hysterectomy for cervical cancer 6 years prior to presentation. Diagnoses: Computed tomography revealed segmental luminal dilatation of pelvic ileal loops, 2 transition zones with the beak sign in the left-sided pelvic cavity, and reduced enhancement of bowel loops. Hydronephrosis with abrupt luminal narrowing of the left distal ureter was also observed. Interventions: Exploratory laparoscopy revealed incarcerated bowel segments beneath an adhesive band. We did not immediately cut the adhesive band and continued to trace the course of the small bowel and attempted reduction of the hernia. Reduction of the hernia was not difficult; therefore, the entire small bowel could be disentangled from the pelvic adhesions without any small bowel injury. After reduction of the herniated small bowel, we could confirm that the adhesive band was the left ureter (ureteral peristalsis was observed). The reduced segments of the small bowel appeared viable, and resection was not required. Outcomes: The patient was discharged 2 days postoperatively without any complication. Lessons: Cutting band during adhesiolysis enables release of bowel obstruction. However, owing to the different types of internal hernias that are known to occur, it is essential to confirm the patient's history and preoperative CT findings to avoid complications.

Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor

“…It is more invasive, yet there are advantages such as a larger operation space, better exposure of the surgical field, a more familiar dissection approach, and a more intuitive anastomotic operation. But there are also some disadvantages: (A) the gastrointestinal gut will be influenced for long time operation; (B) the complete healing time is longer than that of the retroperitoneal laparoscopic pyeloplasty; (C) there is a certain possibility of internal hernia after the operation ( 22 ). The results of this study demonstrate that the transperitoneal approach exhibits notable advantages in the treatment of UPJ obstruction in patients with severe hydrops (with an anteroposterior diameter > 20 mm).…”

Paraureteric space post-ureteric re-implantation: a rare cause of small bowel obstruction

“…The incidence of postsurgical IHs is rising owing to increased numbers of transmesenteric, transmesocoloic and retroanastomotic surgical procedures 2. Nevertheless, pelvic IHs are extremely rare, and only a handful of cases of paraureteric small bowel obstruction have been reported 3–11. We report on an female patient in her 80s who presented with paraureteric small bowel obstruction 2 years after a robotic left distal ureterectomy and left ureteric re-implantation for a transitional cell carcinoma of the bladder and distal ureter.…”