Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion

Abstract

Rationale:Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC).Patient concerns:A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit.Diagnosis:Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion.Interventions:The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found.Outcomes:Both patients recovered smoothly after second operation.Lessons:The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.

Retro-Ileal Conduit Small Bowel Internal Herniation After Radical Cystectomy: A Surgical Complication

“…A series of internal herniation following radical cystectomy was published by Tsa et al in China, which described small bowel herniation between the two ureters. Reduction of hernia was done without any need for bowel resection, which is similar to our case [ 8 ].…”

Small Bowel Obstruction Associated With Ureteral Cutaneous Fistula After a Radical Cystectomy: A Case Report

“…Small bowel obstruction due to internal herniation between ureters and the abdominal wall is extremely rare after radical cystectomy [ 2 ]. Four similar cases have been reported [ 3 - 6 ].To the best of our knowledge, the present case provides the first report of small bowel obstruction due to internal hernia caused by a ureteral cutaneous fistula.…”

An ileal conduit retroperitoneal‐pexy: An novel operative technique to treat the rare colonic internal hernia

“…1,2 Cases describing small bowel herniation between a combination single or both ureters, ileal conduit, ileal-ileal anastomosis and sacrum medially have also been described. 3,4 A systematic review in 2010 looked at peristomal complications following the formation of an ileal conduit. 5 The review categorized ileal-conduit and stoma complications into abdominal wall and peristomal skin changes; internal hernia either small or large bowel through iatrogenic defects was not mentioned.…”

“…This year alone, two case reports describing a retro‐ureteral small bowel obstruction were published 1,2 . Cases describing small bowel herniation between a combination single or both ureters, ileal conduit, ileal–ileal anastomosis and sacrum medially have also been described 3,4 . A systematic review in 2010 looked at peristomal complications following the formation of an ileal conduit 5 .…”