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Incarcerated Retroperitoneal Hernia Following Total Extraperitoneal Laparoscopic Radical Nephrectomy

Milosevic I, Dorion H, Ricchiuti D - JSLS (2011 Jul-Sep)

Bottom Line: We present the case of a 55-year-old male who underwent a laparoscopic left radical nephrectomy and presented with an early SBO.An imaging study revealed an obstructive pattern with proximal dilated jejunum with decompressed distal small bowel.The patient was discharged home, and at 3-month follow-up no bowel complaints were reported.

Affiliation: Department of Surgery, St. Elizabeth Health Center. Youngstown, Ohio, USA. igormilosevic@hotmail.com

ABSTRACT

Small bowel obstruction (SBO) is a common entity encountered in surgical patients. The most common causes of the SBO range from postoperative adhesions to cancer. We present the case of a 55-year-old male who underwent a laparoscopic left radical nephrectomy and presented with an early SBO. An imaging study revealed an obstructive pattern with proximal dilated jejunum with decompressed distal small bowel. The patient underwent an exploratory laparotomy with extensive lysis of adhesions and release/resection of a long segment of incarcerated jejunum from an 8-cm retroperitoneal hernia in the left renal fossa. The patient was discharged home, and at 3-month follow-up no bowel complaints were reported.

Dilated loops of jejunum.
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Figure 1: Dilated loops of jejunum.

Mentions: Three weeks after admission, the patient presented to the emergency department with nausea, vomiting, and abdominal pain. The physical examination demonstrated normal vital signs, a distended abdomen, and mild to moderate, diffuse abdominal tenderness without peritoneal signs. The surgical incisions were healing well, and no evidence of abdominal wall herniation was present. Admission laboratory values were significant for leukocytosis, a minimally elevated serum creatinine level (1.5mg/dL), and hyperglycemia (195mg/dL). Serum lactate, electrolytes, amylase, and lipase levels were normal. A contrast enhanced CT of the abdomen and pelvis was performed immediately upon the patient being admitted and demonstrated a dilated proximal jejunum, a 6-cm stenotic segment of jejunum in the left retroperitoneum, and a decompressed distal small bowel and colon (Figure 1).

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Incarcerated Retroperitoneal Hernia Following Total Extraperitoneal Laparoscopic Radical Nephrectomy

Milosevic I, Dorion H, Ricchiuti D - JSLS (2011 Jul-Sep)

Dilated loops of jejunum.
© Copyright Policy
Figure 1: Dilated loops of jejunum.
Mentions: Three weeks after admission, the patient presented to the emergency department with nausea, vomiting, and abdominal pain. The physical examination demonstrated normal vital signs, a distended abdomen, and mild to moderate, diffuse abdominal tenderness without peritoneal signs. The surgical incisions were healing well, and no evidence of abdominal wall herniation was present. Admission laboratory values were significant for leukocytosis, a minimally elevated serum creatinine level (1.5mg/dL), and hyperglycemia (195mg/dL). Serum lactate, electrolytes, amylase, and lipase levels were normal. A contrast enhanced CT of the abdomen and pelvis was performed immediately upon the patient being admitted and demonstrated a dilated proximal jejunum, a 6-cm stenotic segment of jejunum in the left retroperitoneum, and a decompressed distal small bowel and colon (Figure 1).

Bottom Line: We present the case of a 55-year-old male who underwent a laparoscopic left radical nephrectomy and presented with an early SBO.An imaging study revealed an obstructive pattern with proximal dilated jejunum with decompressed distal small bowel.The patient was discharged home, and at 3-month follow-up no bowel complaints were reported.

Affiliation: Department of Surgery, St. Elizabeth Health Center. Youngstown, Ohio, USA. igormilosevic@hotmail.com

ABSTRACT

Background: Small bowel obstruction (SBO) is a common entity encountered in surgical patients. The most common causes of the SBO range from postoperative adhesions to cancer. We present the case of a 55-year-old male who underwent a laparoscopic left radical nephrectomy and presented with an early SBO. An imaging study revealed an obstructive pattern with proximal dilated jejunum with decompressed distal small bowel. The patient underwent an exploratory laparotomy with extensive lysis of adhesions and release/resection of a long segment of incarcerated jejunum from an 8-cm retroperitoneal hernia in the left renal fossa. The patient was discharged home, and at 3-month follow-up no bowel complaints were reported.

View Similar Images In: Results  - Collection
View Article: Medline Plus - Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3183559&rFormat=json&query=null&req=5