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Multimodality Diagnosis of Mesenteric Ischemia
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High Grade Intestinal Obstruction From Internal Hernia Beneath an Intraperitoneal External Iliac Artery.

Christen E Chaconas1, Isabella C Moncada1, Antonio P Pepe1

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Acute small bowel obstruction (SBO), a frequent surgical emergency, can rarely be caused by retroperitoneal vessel exposure. This case highlights a unique cause of SBO years after surgery.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Vascular Surgery

Background:

  • Acute small bowel obstruction (SBO) is a common cause of emergency visits and surgical operations in the US.
  • SBO etiology includes intrinsic luminal or extrinsic bowel compression, with intraperitoneal adhesions from prior surgery being the most frequent cause (60-70%).

Observation:

  • The abdominal cavity is divided into peritoneal and retroperitoneal spaces.
  • A rare case of SBO was observed, stemming from exposure of the retroperitoneal external iliac artery.

Findings:

  • The patient presented with acute small bowel obstruction.
  • The obstruction was found to be secondary to the retroperitoneal external iliac artery, exposed during a prior surgical procedure 20 years earlier.

Implications:

  • This case underscores the importance of considering rare etiologies for SBO, even long after initial surgery.
  • Understanding the anatomical divisions of the abdominal cavity is crucial for diagnosing and managing complex surgical cases.