A case of strangulated bowel obstruction caused by the lateral umbilical ligament after laparoscopic radical hysterectomy

A 40-year-old woman, G4P2, presented after an abnormal gynecological screening indicated ASC-US. Subsequent cervical biopsy led to diagnosis of HSIL/CIN3, followed by a cervical conization. Histopathology revealed HPV-related adenocarcinoma (usual type endocervical adenocarcinoma), stage IB1, without vascular invasion and with negative surgical margins. The patient underwent a laparoscopic radical hysterectomy and bilateral adnexectomy. No residual tumor was detected, confirming the final diagnosis of HPV-related adenocarcinoma, pT1b1N0M0. Two months post-surgery, the patient presented with acute abdominal pain. A contrast abdominal CT scan suggested a strangulated small bowel obstruction, prompting emergency laparotomy. The small intestine was found incarcerated at the right umbilical ligament, serving as a hernial orifice and causing strangulated obstruction. Strangulation release and partial small bowel resection were performed. Due to the difficulty of closing the right retroperitoneal space, the gap in the right umbilical ligament was filled with omentum. Currently, the patient is under outpatient observation with no signs of recurrence or bowel obstruction symptoms. Strangulated bowel obstruction is a critical condition that can lead to bowel necrosis, peritonitis, sepsis, and multi-organ failure. Postoperative cases suggest that exposed vascular structures after lymphadenectomy can serve as hernial orifices, indicating the need for vigilance for strangulated bowel obstruction after pelvic lymph node dissection in gynecological malignancy surgeries.