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Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion: Two case reports.
Medicine (Baltimore) 2019; 98(41):e17222M

Abstract

RATIONALE

Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC).

PATIENT CONCERNS

A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit.

DIAGNOSIS

Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion.

INTERVENTIONS

The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found.

OUTCOMES

Both patients recovered smoothly after second operation.

LESSONS

The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.

Authors+Show Affiliations

Department of Urology, China Medical University Hospital, North District, Taichung, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31593079

Citation

Tsai, Li-Hsien, et al. "Internal Hernia From the Interureteric Space After Robot-assisted Radical Cystectomy and Urinary Diversion: Two Case Reports." Medicine, vol. 98, no. 41, 2019, pp. e17222.
Tsai LH, Li WJ, Chen GH, et al. Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion: Two case reports. Medicine (Baltimore). 2019;98(41):e17222.
Tsai, L. H., Li, W. J., Chen, G. H., Hsieh, P. F., & Chang, C. H. (2019). Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion: Two case reports. Medicine, 98(41), pp. e17222. doi:10.1097/MD.0000000000017222.
Tsai LH, et al. Internal Hernia From the Interureteric Space After Robot-assisted Radical Cystectomy and Urinary Diversion: Two Case Reports. Medicine (Baltimore). 2019;98(41):e17222. PubMed PMID: 31593079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion: Two case reports. AU - Tsai,Li-Hsien, AU - Li,Wei-Juan, AU - Chen,Guang-Heng, AU - Hsieh,Po-Fan, AU - Chang,Chao-Hsiang, PY - 2019/10/9/entrez PY - 2019/10/9/pubmed PY - 2019/10/18/medline SP - e17222 EP - e17222 JF - Medicine JO - Medicine (Baltimore) VL - 98 IS - 41 N2 - RATIONALE: Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC). PATIENT CONCERNS: A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit. DIAGNOSIS: Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion. INTERVENTIONS: The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found. OUTCOMES: Both patients recovered smoothly after second operation. LESSONS: The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/31593079/Internal_hernia_from_the_interureteric_space_after_robot-assisted_radical_cystectomy_and_urinary_diversion:_Two_case_reports L2 - http://dx.doi.org/10.1097/MD.0000000000017222 DB - PRIME DP - Unbound Medicine ER -