Small bowel incarceration in the umbilical artery following total laparoscopic radical hysterectomy

Abstract

Total laparoscopic radical hysterectomy (TLRH) has demonstrated to be a feasible and safe technique for patients affected of early cervical cancer. Small bowel obstruction resulting from a loop volvulus represents a very uncommon postoperative complication in gynecological laparoscopic surgery. We report a case of a patient who presented an intestinal obstruction following a TLRH for cervical cancer. The obstruction was caused by entrapment of a segment of small bowel under the dissected obliterated umbilical artery resulting in a loop incarceration. Wide radical pelvic dissection in radical hysterectomy usually leaves uncovered many dissected retroperitoneal structures. Postoperative bands and adhesions represent the main cause of bowel obstruction after a surgical procedure. Retroperitoneal vessel dissection is mandatory to achieve safely an adequate radicality, but it may lead to intestinal complications that should be taken into account. To our knowledge, this is the first report of postoperative bowel incarceration through the umbilical artery after a laparoscopic oncological procedure.