Colonic obstruction secondary to incarcerated transiliac bone hernia

Abstract

Transiliac bone hernias are a rare cause of intestinal obstruction, and high clinical suspicion is required for their diagnosis.

Transiliac bone hernias are a rare cause of intestinal obstruction, and high clinical suspicion is required for their diagnosis.

1. CASE DESCRIPTION

Herniation of abdominal viscera through pelvic bone defects represents a very rare complication following orthopedic interventions. We report a case of acute colonic obstruction through a defect in the iliac bone, following bone graft harvesting from the iliac crest, aiming to raise clinical awareness of this rare clinical entity.

A 77‐year‐old Caucasian female patient presented to our acute surgical take with complaints suggestive of intestinal obstruction, comprising of abdominal distension, vomiting, and sharp pain localized in the left iliac fossa. Her underlying medical comorbidities included congestive heart failure, hypertension, diabetes mellitus and previous right knee and hip replacements, along with extraction of left iliac bone graft for spinal surgery. Clinical examination revealed a moderately distended but soft abdomen, with tenderness in deep palpation in the left iliac fossa, without identification of an obvious external hernia. Provisional diagnosis was that of intestinal obstruction and hence an urgent abdominopelvic computed tomography (CT) scan with intravenous contrast was performed for further assessment. The performed CT scan revealed the presence of closed loop colonic obstruction between a competent ileocecal valve and the distal descending colon, which had herniated through the left iliac bone, with no obvious evidence of intestinal ischemia or perforation (Figures 1 and 2). The patient was scheduled for emergency laparotomy. Intraoperatively, the herniated colonic segment was gently reduced. Upon its inspection, there were no signs of ischemia or constriction and hence no resection was required. The defect in the iliac bone was closed with the use of bridging synthetic polypropylene mesh. The patient had an uneventful recovery and was discharged in a stable condition, with no evidence of clinical recurrence at 6 months postoperatively.

FIGURE 1.

Axial view of the preoperative CT scan showing the site of the incarcerated transiliac bone hernia, with part of the descending colon protruding through the defect (red arrow). Note the presence of cecal dilatation (yellow arrow), which in absence of small bowel dilatation, was suggestive of closed loop colonic obstruction and mandated urgent laparotomy

FIGURE 2.

Sagittal view of the preoperative CT scan showing the site of the incarcerated transiliac bone hernia (red arrow), with evident proximal colonic obstruction (yellow arrow)

Our case highlights the need for high clinical suspicion of a transiliac bone hernia in patients with previous relevant orthopaedic interventions, who present with features of intestinal obstruction, as highlighted by the previous very limited reports in the literature. ¹ , ² Since clinical examination is usually insufficient to establish the diagnosis, we advocate urgent performance of abdominopelvic computed tomography for diagnostic and preoperative planning purposes, followed by prompt surgical intervention, with liberal use of prosthetic mesh to reduce the chance of recurrence of the hernia.

CONFLICT OF INTEREST

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

AUTHOR CONTRIBUTIONS

CS: contributed to the clinical data collection and prepared the case report; KM and BP: contributed to the design of the case report presentation and performed the final revision of the manuscript.

ETHICAL APPROVAL

Approval from Ethics Committee was not required for this study; informed consent has been obtained from the patient and is available upon request by the Editorial Office.

Seretis C, Marimuthu K, Piramanayagam B. Colonic obstruction secondary to incarcerated transiliac bone hernia. Clin Case Rep. 2021;9:1799–1800. 10.1002/ccr3.3777

DATA AVAILABILITY STATEMENT

All data referred to in the study reside within the manuscript and supplementary material.