A rare case of intestinal internal hernia beneath the external iliac artery following radical cystectomy

Gastrointestinal complications following radical cystectomy (RC) are a common occurrence, with small bowel obstruction (SBO) a known complication. Limited cases have been reported of SBO following RC due to internal herniation of the small intestine around the ureter, ileal conduit, obturator nerve and, as a consequence of retroperitoneal lymphadenectomy, even the abdominal vasculature. We present a rare case in which intestinal herniation beneath the external iliac artery (EIA) resulted in a closed-loop SBO with ischaemia and necrosis. Intra-operative transection of the unrecognised EIA occurred, necessitating primary arterial repair. This case highlights the importance of maintaining a high index of suspicion for complex pathology and anatomical variations in patients following RC and other operations involving retroperitoneal lymphadenectomy.