# Unusual presentation of ‘internal hernia’ after robot-assisted radical cystectomy

## TL;DR

A patient developed a rare internal hernia after a robotic bladder cancer surgery, requiring emergency surgery to fix the intestinal obstruction.

## Contribution

This is the first reported case of internal hernia occurring in the space between the ureter and muscle fascia after robot-assisted cystectomy.

## Key findings

- An 82-year-old man developed a strangulated internal hernia post-robot-assisted cystectomy.
- Emergency surgery revealed intestinal prolapse through the space between the ureter and transversalis fascia.
- The patient recovered uneventfully after resection and a new uretero-cutaneostomy was created.

## Abstract

Here is presented the first case of internal hernia developing from the space between ureter and muscle fascia after robot-assisted radical cystectomy with uretero-cutaneostomy diversion. An 82-year-old man underwent robot-assisted radical cystectomy with uretero-cutaneostomy diversion for high-grade urothelial carcinoma (pT2). On the Postoperative Day 7, the patient presented abdominal pain and nausea. Abdominal computed tomography showed that a part of the small intestine was protruding between the right ureter and the transverse fascia, and was strangulated, causing an obstruction of the intestine. Patient underwent an emergency laparotomy that revealed prolapse and strangulation of the small intestine through the space between the right ureter and the transversalis fascia. The ischemic intestinal tract and ureter were resected. A new right uretero-cutaneostomy diversion anastomosis with use of ureteral stent single J was created. The man was discharged 28 days after surgery, and his clinical course was uneventful through follow-up.