High Grade Intestinal Obstruction From Internal Hernia Beneath an Intraperitoneal External Iliac Artery

Acute small bowel obstruction (SBO) is a common cause of emergency department visits in the United States, and it accounts for approximately 20% of emergency surgical operations.¹ Its etiology is divided into intrinsic luminal obstruction or extrinsic compression of the bowel.² Among the causes of SBO, by far the most common is intraperitoneal adhesions due to previous abdominal surgeries, which comprises about 60-70% of the cases.² The abdominal cavity is subdivided into the peritoneal cavity and the retroperitoneal cavity; the division is marked by a thin covering of parietal peritoneum that encases all the intraperitoneal structures. Here, we present a rare case of an acute small bowel obstruction secondary to exposure of the retroperitoneal external iliac artery from a surgical procedure 20 years prior to presentation.