Case Presentation: Internal Herniation Causes Double Obstruction, Small Bowel and Urinary Tract

Aim The presentation of a rare case of small bowel obstruction accompanied by obstruction of the urinary tract, due to an internal hernia caused by the ureter, as a secondary complication of ureteroplasty. Material and Methods A 58-year-old female, who underwent hysterectomy-right ureter injury-ureteroplasty ten years ago, presented to the Emergency Department with acute abdominal and right lumbar region pain accompanied by nausea. Clinical examination showed tenderness in the lower abdomen, positive Giordano's sign on the right, and metallic bowel sounds. A Computer Tomography scan revealed right- sided hydronephrosis with perinephric stranding, and absence of excretion in the right urinary tract. In the pelvic cavity, dilated loops of the small intestine were observed, and at the same level, a point of luminal narrowing of the right distal ureter. Results The patient underwent an investigative laparoscopy-laparotomy-resection of a segment of the ileum and oblique anastomosis-reimplantation of the right ureter, and placement of a ureteral catheter. The postoperative course was uneventful, and the patient was discharged 8 days postoperatively, with the ureteral catheter removed 30 days later. Conclusions The literature contains very few cases of internal herniation beneath the ureter, with retro-ureteral small bowel incarceration and simultaneous urinary tract obstruction. These cases typically involve patients who have undergone either gynecological surgeries or kidney transplant procedures. Surgical history should be strongly considered in the diagnostic approach, in order to recognize even rarer causes of small bowel obstruction.