[Internal herniation underneath the left external iliac artery after radical prostatectomy with extensive lymph node...

Area of Science:

• Abdominal Surgery
• Gastroenterology
• Surgical Complications

Background:

• Internal herniation can occur after abdominal surgery, leading to bowel compromise.
• Iatrogenic peritoneal defects pose a risk for subsequent internal hernias.
• Robot-assisted radical prostatectomy with pelvic lymph node dissection can create such defects.

Purpose of the Study:

• To report a case of small bowel ischemia secondary to internal herniation through an iatrogenic peritoneal defect.
• To highlight the management of acute bowel ischemia in this context.
• To discuss the surgical repair and subsequent stoma management.

Main Methods:

• Case report of a 65-year-old male patient.
• Diagnosis of internal herniation causing small bowel ischemia.
• Surgical management involving laparotomy, bowel resection, and temporary stoma creation.
• Subsequent surgical closure of the stoma.

Main Results:

• The patient presented with acute small bowel ischemia due to internal herniation.
• Emergency laparotomy and resection of ischemic bowel were performed.
• A temporary stoma was necessary for fecal diversion.
• The patient recovered well, and the stoma was successfully closed two months later.

Conclusions:

• Internal herniation through iatrogenic defects is a potential, albeit rare, complication after pelvic surgery.
• Prompt surgical intervention is crucial for managing acute bowel ischemia caused by internal herniation.
• Multistage surgical management, including stoma creation and subsequent closure, can lead to favorable outcomes.