Palliative surgery for recurrent bowel obstruction due to advanced ovarian cancer

AIM: Intestinal obstruction is a frequent event in patients affected by ovarian carcinoma. Little data on repeat palliative surgery for recurrent bowel obstruction are available. The aim of this study was to analyze postoperative and long term outcomes of ovarian cancer patients who underwent reoperation for recurrent intestinal obstruction. METHODS: We retrospectively evaluated the records of these patients treated at our Department between 1992 and 2002. RESULTS: Nine women with a mean age of 56 years (range 37-72) were identified. All patients had undergone previous abdominal surgery for bowel obstruction from ovarian cancer. All patients underwent exploratory laparotomy. In 4 patients (Group A) because of advanced disease, only exploratory surgery was carried out. A surgical correction was achieved in the other 5 patients (Group B), but only 3 patients had a successful palliation, defined as the ability to tolerate an oral intake for at least 60 days postoperatively. Postoperative mortality was nil, morbidity was 44.4%; particularly 2 patients developed an enterocutaneous fistula. Mean survival of Group A and B patients were 36.7 and 96.2 days respectively. The 3 successful palliated patients died of disease after 3.5, 4 and 5 months, in 2 cases for recurrent bowel obstruction. CONCLUSIONS: Repeat surgery for recurrent bowel obstruction in advanced ovarian carcinoma may achieve successful palliation in few cases and is associated with high postoperative morbidity and limited survival. In these patients non surgical approaches based on medical treatment, percutaneous endoscopic gastrostomy and stent placement should be considered.     

Gastric necrosis associated with acute gastric dilatation and small bowel obstruction

BACKGROUND: While acute gastric dilation is a postoperative complication familiar to most surgeons, massive dilatation with necrosis and rupture is a very rare event. We performed a computer search in the MEDLINE database for the years 1966-2001 for articles published in any language using the key words gastric dilation, gastric necrosis, intestinal obstruction, and gynecologic surgery. Our search yielded no reports of massive gastric dilation and ischemic necrosis from a small bowel obstruction following gynecologic surgery. CASE: A 76-year-old woman developed massive gastric dilatation with ischemic necrosis associated with small bowel obstruction following gynecologic surgery for benign disease. CONCLUSION: Gynecologists should be aware of the entity. Early diagnosis and treatment are essential to minimize morbidity and mortality.     

Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC)

Objective

To describe the outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC) so as to define the criteria for patient selection for palliative surgery.

Methods

90 women with relapsed EOC underwent palliative surgery for bowel obstruction between 1992 and 2008.

Results

Median age at time of surgery for bowel obstruction was 57 years (range, 26 to 85 years). All patients had received at least one line of platinum-based chemotherapy. Median time from diagnosis of primary disease to documented bowel obstruction requiring surgery was 19.5 months (range, 29 days-14 years). Median interval from date of completed course of chemotherapy preceding surgery for bowel obstruction was 3.8 months (range, 5 days-14 years). Ascites was present in 38/90(42%). 49/90(54%) underwent emergency surgery for bowel obstruction. The operative mortality and morbidity rates were 18% and 27%, respectively. Successful palliation, defined as adequate oral intake at least 60 days postoperative, was achieved in 59/90(66%). Only the absence of ascites was identified as a predictor for successful palliation (p = 0.049). The median overall survival (OS) was 90.5 days (range, < 1 day-6 years). Optimal debulking, treatment-free interval (TFI) and elective versus emergency surgery did not predict survival or successful palliation from surgery for bowel obstruction (p > 0.05).

Conclusion

Surgery for bowel obstruction in relapsed EOC is associated with a high morbidity and mortality rate especially in emergency cases when compared to other gynaecological oncological procedures. Palliation can be achieved in almost two thirds of cases, is equally likely in elective and emergency cases but is less likely in those with ascites.     

Gastrointestinal surgery in patients with ovarian cancer

OBJECTIVES: The objectives were to assess indications for and outcome and morbidity of gastrointestinal surgery in patients with ovarian cancer. METHODS: We reviewed 364 patients with ovarian cancer who underwent a total of 491 operations including a gastrointestinal procedure over a 10-year period. The 491 operations comprised 180 primary surgical procedures (37%), 44 second-look laparotomies (9%), and 267 procedures for recurrence or palliation (54%). RESULTS: Debulking of disease was the indication for bowel surgery for 87, 45, and 62% of cases in the three groups, respectively. Bowel obstruction was an indication in 14% of patients at primary surgery and in 34% at secondary surgery (P < 0.05). Rectosigmoid resection was the most common bowel operation overall, particularly in the primary surgery group (65%). Colostomy was performed in 30% of the cases of rectosigmoid resection at primary surgery. Small-bowel resection was most common in the surgery for recurrence or palliation group. The blood transfusion rate was 79%. Febrile morbidity was the most common complication overall (29%), with no significant differences among groups. Four patients (0.8%) required reoperation for an abscess or anastomotic leak. Nineteen operations (3.9%) were followed by death within 30 days, with no significant differences among groups. A weighted Cox model estimated that 21, 42, and 11% of patients would be alive 5 years after primary surgery, second-look laparotomy, and surgery for recurrence or palliation, respectively (P = 0.01). CONCLUSION: Gastrointestinal surgery is frequently indicated during operations for ovarian cancer. Gynecologic cancer surgeons should be trained accordingly. Patients with possibly malignant ovarian masses should receive preoperative bowel preparation and be counseled that bowel surgery may be needed but colostomy is not frequently required.     

Witzel Gastrostomy in Gynecologic Surgery

Tube gastrostomy is a well-accepted procedure for gastrointestinal decompression and the relief of small bowel obstruction. The Witzel technique was used in 123 patients undergoing pelvic–abdominal surgery for known or suspected gynecologic malignancy or for clinical bowel obstruction. For 115 patients, the tube remained in place from 3 to 18 days (mean, 8 days). Eight patients were discharged from the hospital with the tube in place, and these functioned successfully from 43 to 136 days. Sixteen patients (13%) had complications, but there was neither long-term morbidity nor mortality associated with the tube. Witzel gastrostomy, using a Foley catheter, is easily learned, inexpensive, and has an acceptable complication rate. When the need for long-term gastrointestinal decompression is anticipated, Witzel gastrostomy is preferred to nasogastric tube suctioning to facilitate patient care and comfort.     

Reoperation for palliation of recurrent malignant bowel obstruction in ovarian carcinoma

OBJECTIVE: While initial surgical treatment for palliation of malignant bowel obstruction is well described, data on reoperation for palliation of recurrent obstruction in ovarian carcinoma are limited. The purpose of this study was to analyze the outcome of patients undergoing reoperation for repeat bowel obstruction. METHODS: We reviewed the records of all patients with ovarian cancer who underwent repeat surgery for recurrent, malignant bowel obstruction at our institution between 1994 and 2002. RESULTS: Ten patients were identified. All patients had bowel obstruction caused by recurrent ovarian carcinoma and had a previous corrective surgical procedure for malignant bowel obstruction. The mean age at diagnosis of repeat obstruction was 54.1 years (range, 34-74 years). All patients had initial stage III or IV disease with moderately to poorly differentiated cancers. No patient received prior radiation therapy. The sites of obstruction in patients were as follows: small bowel, 3; large bowel, 3; both small and large bowel, 4. The mean number of prior laparotomies was 2.7 (range, 2-5). The mean interval from previous surgery for bowel obstruction to recurrent bowel obstruction was 8.3 months (range, 1-22 months). Surgical correction was possible in 5 (50%) of 10 patients, with 3 (60%) of these 5 patients obtaining successful palliation. Successful palliation is defined as the ability to tolerate a regular or low-residue diet at least 60 days postoperatively. Complications included enterocutaneous fistulas in three patients (two had enterotomies at time of surgery) and wound infection in one patient. There were no postoperative mortalities. The mean postoperative stay was 15.8 days (range, 8-29 days). Two of the three patients successfully palliated presented with a subsequent obstruction at 3 and 5 months postoperatively and were treated with gastrostomy tubes. The median length of survival for the entire cohort from the date of surgery for repeat obstruction was 4.5 months (range, 3-17 months). CONCLUSIONS: Patients undergoing repeat surgery for recurrent bowel obstruction have a low likelihood of successful palliation (30%). The surgery is associated with significant complications after surgery, rapid development of subsequent bowel obstructions, and limited survival rates. Alternative management approaches such as percutaneous endoscopic gastrostomy (PEG) tube placement should be considered in this group of patients.     

Systematic review of surgery in malignant bowel obstruction in advanced gynecological and gastrointestinal cancer. The Systematic Review Steering Committee

OBJECTIVE: The objective was to locate, appraise, and summarize evidence from scientific studies on intestinal obstruction due to advanced gynecological and gastrointestinal cancer in order to assess the efficacy of surgery. MATERIALS AND METHODS: Data sources: A comprehensive list of studies was provided by an extensive search of electronic databases, relevant journals, bibliographic databases, conference proceedings, reference lists, the gray literature, personal contact, and the worldwide web. Data synthesis: Two researchers extracted the data independently. Due to the methodological quality of the studies, only a qualitative assessment was possible. RESULTS: The role of surgery in malignant bowel obstruction remains controversial, and no firm conclusions from the many retrospective case series can be made. Control of symptoms varies from 42% to over 80%, although it is often unclear how symptoms were measured and whether the symptom scores used are validated. There is a large range in the rates of reobstruction, from 10 to 50%, although time to reobstruction was often not included. There is a wide range of postoperative morbidity and mortality, although again the definition of both of these surgical outcomes varied among many of the papers. CONCLUSION: The role of surgery in malignant bowel obstruction needs careful evaluation, using validated outcome measures on symptom control and quality of life scores. Further information would include reobstruction rates together with the morbidity associated with the various surgical procedures. Currently, bowel obstruction is managed empirically, and there are marked variations in clinical practice by different units. There needs to be a greater standardization of management so that comparisons between different series can be made.     

Can we identify the patients who are likely to undergo bowel resection at the time of surgery for ovarian cancer?

Surgery for ovarian cancer carries a risk of bowel resection to either achieve optimal debulking or relieve obstruction. This prospective study assessed the likelihood of bowel resection in 842 women undergoing surgery for ovarian cancer and identified factors associated with increased risk. Bowel resection was performed in 8.6% of women. The likelihood of bowel resection increased significantly (p < 0.0001, chi2 test) with: Secondary surgery (22% vs 5.8% at primary surgery). Symptoms of bowel disturbance (21.9% vs 6.3% if no symptoms). FIGO stage III/IV disease (12.8% vs 2% in stage I/II). CA125 levels >or=2500 (12.9% vs 4.8% if CA125<2500). These women should be selectively offered pre-operative computerised tomography, stoma marking and counselling by stoma nurses. The 5-year survival was 14% in patients following bowel resection compared with 44% in patients not having bowel resection. Bowel resection should be performed only if it will result in optimal debulking or it relieves imminent bowel obstruction.     

Small bowel obstruction in pregnancy

Background Intestinal obstruction in pregnancy is rare. Symptoms are often unspecific and a high level of suspicion is essential for early diagnosis. Fetal and maternal mortality rates are higher during pregnancy due to delay in diagnosis. Case A 31-year-old primigravida with a history of abdominal surgery was admitted because of worsening abdominal pain, abdominal distension and elevated pancreatic enzymes. Ultrasound showed dilated small bowel loops. Explorative laparotomy revealed a small bowel obstruction with partial bowel necrosis caused by a single adhesion. A jejuno-jejunostomy was performed. Five days later, she developed peritonitis. A secondary laparotomy and caesarean section were done. Conclusion In spite of timely diagnosis and prompt surgical intervention, our case was still complicated by peritonitis and early delivery. This underlines the necessity of immediate clinical suspicion. Small bowel obstruction should be considered in differential diagnosis of pregnant patients with a history of abdominal surgery.     

Documento de consenso del Grupo de Trabajo sobre las Adherencias de la sección de endoscopia de la SEGO

Adhesions are the most frequent complication of abdominopelvic surgery. These complications have major short- and long-term consequences, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. Adhesions complicate future surgery, leading to high associated morbidity and expense and a considerable risk of mortality. Despite advances in surgical techniques, the burden of adhesion-related complications has remained unchanged in recent years. Adhesiolysis is still the main treatment, although adhesions reform in most patients. This consensus position provides a comprehensive overview of adhesions and their consequences and describes practical proposals for actions that gynecological surgeons in Spain should take. Developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving patient outcomes.     

Systematic Review of Surgery in Malignant Bowel Obstruction in Advanced Gynecological and Gastrointestinal Cancer

Objective.The objective was to locate, appraise, and summarize evidence from scientific studies on intestinal obstruction due to advanced gynecological and gastrointestinal cancer in order to assess the efficacy of surgery.Materials and methods. Data sources: A comprehensive list of studies was provided by an extensive search of electronic databases, relevant journals, bibliographic databases, conference proceedings, reference lists, the gray literature, personal contact, and the worldwide web. Data synthesis: Two researchers extracted the data independently. Due to the methodological quality of the studies, only a qualitative assessment was possible.Results. The role of surgery in malignant bowel obstruction remains controversial, and no firm conclusions from the many retrospective case series can be made. Control of symptoms varies from 42% to over 80%, although it is often unclear how symptoms were measured and whether the symptom scores used are validated. There is a large range in the rates of reobstruction, from 10 to 50%, although time to reobstruction was often not included. There is a wide range of postoperative morbidity and mortality, although again the definition of both of these surgical outcomes varied among many of the papers.Conclusion. The role of surgery in malignant bowel obstruction needs careful evaluation, using validated outcome measures on symptom control and quality of life scores. Further information would include reobstruction rates together with the morbidity associated with the various surgical procedures. Currently, bowel obstruction is managed empirically, and there are marked variations in clinical practice by different units. There needs to be a greater standardization of management so that comparisons between different series can be made.     

Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis

Bowel obstruction is the most common complication in patients with ovarian cancer. Management of this situation is controversial. The aim of our retrospective study was to determine the best approach for managing bowel obstruction in recurrent ovarian cancer. A retrospective analysis of data on 47 patients with intestinal obstruction by ovarian cancer was performed. Twenty-seven patients were submitted to surgery, with 21 intestinal procedures performed, 2 gastrostomy tubes placed, and 4 patients deemed inoperable. Twenty patients were managed medically with Octreotide (mean dosage of 0.48 mg/day), of which 1 patient required a nasogastric tube. Age, performance status, diagnosis of tumor to occlusion time, obstruction site, previous chemotherapy or radiotherapy, presence of ascites, or palpable masses were the variables analyzed. Student's t-test and Pearson chi-square test were used to compare the two different groups of treatment (surgical vs medical therapy). Disease-free-survival curves were plotted according to the Kaplan-Meier method and analyzed by the log-rank test. Cox's proportional hazards model was used for multivariate analysis. Values less than or equal to 0.05 were considered significant. The mean age of the patients was 58.7 years. Perioperative mortality and morbidity were both 22%. All patients died with minimal distress. Performance status results were significantly different between the patients submitted to surgery and patients treated with Octreotide (P= 0.03). No significant differences were found in the other variables analyzed. In multivariate analysis, only type of treatment emerges as a strong predictor of poor outcome (P < 0.001). Both surgery and Octreotide therapy are able to control distressing symptoms in end-stage ovarian cancer. Survival was significantly longer in the surgical group, and surgical palliation should be considered first in patients with good performance status.     

Postlaparoscopic small bowel obstruction secondary to unrecognized nodular endometriosis of the terminal ileum

Small bowel involvement by endometriosis occurs in about 0.5% of patients, but nodular endometriosis involving the entire wall of the terminal ileum is extremely rare. Endometriotic nodules protruding into the intestinal lumen may lead to chronic, partial, or acute complete small bowel obstruction and associated clinical changes. If obstruction is partial, preoperative diagnosis is difficult and seldom suspected, and no reliable diagnostic tests are available. At laparoscopic surgery, performed typically for associated pelvic endometriosis, bowel lesions may easily be overlooked, especially in women with abdominal adhesions from earlier surgery. Surgical injury, tension tears, or postoperative edema may contribute in such cases to the development of acute, complete small bowel obstruction, which may be difficult to differentiate from postoperative ileus. The patient may deteriorate rapidly and develop abdominal sepsis and multiple organ failure with high risk of mortality. Because of increased production of tumor necrosis factor-alpha by autologous monocytes, endometriosis may predispose to development of severe sepsis and septic shock. (J Am Assoc Gynecol Laparosc 8(1):161-166, 2001)     

复发性卵巢癌合并肠梗阻行姑息性手术的临床分析

目的分析复发性卵巢癌患者合并肠梗阻行姑息性手术治疗的临床应用。方法回顾分析1997-2002年采用姑息性手术治疗(手术治疗)的67例复发性卵巢癌合并肠梗阻患者,并与同期未行手术治疗(非手术治疗)的75例复发性卵巢癌合并肠梗阻患者进行比较。采用COX回归分析法,分析行手术治疗患者选择的参考指标。结果手术治疗的67例患者中,58例(86．6％)完成预期手术操作,43例症状获得成功缓解,缓解率64．2％(43／67),占所有肠梗阻患者的30．3％(43／142)。67例患者的中位数生存期为7．8个月,43例症状获得成功缓解患者的中位数生存期为12．6个月;非手术治疗患者的中位数生存期为3．7个月。67例患者的围手术期死亡率为6．0％(4／67),并发症发生率为22．4％(15／67)。单纯结肠发生梗阻和复发肿块位于盆腔,可作为采用手术治疗患者选择的参考指标。结论采用姑息性手术治疗复发性卵巢癌合并肠梗阻,可使约1／3的患者获得较好疗效;而选择恰当的患者,是手术治疗的关键。     

Prevention of postoperative abdominal adhesions in gynecological surgery. Consensus paper of an Italian gynecologists' task force on adhesions

Adhesions are the most frequent complication of abdominopelvic surgery, causing important short- and long-term problems, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. They also complicate future surgery with considerable morbidity and expense, and an important mortality risk. They pose serious quality of life issues for many patients with associated social and healthcare costs. Despite advances in surgical techniques, the healthcare burden of adhesion-related complications has not changed in recent years. Adhesiolysis remains the main treatment although adhesions reform in most patients. There is rising evidence, however, that surgeons can take important steps to reduce the impact of adhesions. A task force of Italian gynecologists with a specialist interest in adhesions having reviewed the current evidence on adhesions and considered the opportunities to reduce adhesions in Italy, have approved a collective consensus position. This consensus paper provides a comprehensive overview of adhesions and their consequences and practical proposals for actions that gynecological surgeons in Italy should take. As well as improvements in surgical technique, developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving outcomes for patients. They should be adopted particularly in high risk surgery and in patients with adhesiogenic conditions. Patients also need to be better informed of the risks of adhesions.     

Salvage whole-abdominal radiation therapy after second-look laparotomy or secondary debulking surgery in patients with ovarian cancer

OBJECTIVES: Our aim was to determine the outcomes associated with use of whole-abdominal radiation therapy (WART) in women with ovarian cancer, to identify predictors of response, and to assess associated toxicity. METHODS: From 1981 through 2000, 171 women received WART at our institution after ovarian cancer surgery. Relevant clinical information was extracted through retrospective chart review. RESULTS: One hundred nine patients received WART after positive second-look laparotomy (SLL), and 62 were treated after secondary debulking (SD) for recurrent disease. The median dose to the whole abdomen was 25.5 Gy (range, 1.0-30.5 Gy). Therapy included a pelvic boost in 120 patients (70%) and a para-aortic boost in 21 patients (12%). The planned radiation course was completed in 123 patients (72%). In the SLL group, 5-year survival was 29% with a median follow-up of 98.4 months. The 5-year progression-free survival (PFS) was 41% in those with microscopic disease. There was one treatment-related death (1%). For the SD group, median PFS was 11 months and associated with treatment-related mortality in 5%. Overall, treatment-related small bowel obstruction occurred in 26 patients (15%). CONCLUSIONS: In patients with a positive SLL, WART should be considered only for those with microscopic residual disease. Treatment-related small bowel obstruction can be expected in 15% of these patients. Use of WART for recurrent disease appears to be related to serious bowel toxicity in 5% with an associated short disease-free interval; the therapeutic index of WART may not be acceptable in patients with recurrent disease regardless of the degree of cytoreduction.     

18例妇科恶性肿瘤结肠、直肠手术临床分析

目的 探讨结肠、直肠手术在治疗卵巢上皮性癌和原发腹膜癌患者的手术指征和治疗效果。方法 对1988年6月～2001年5月在我院妇科接受开腹手术同时行结肠、直肠手术的18例妇科恶性肿瘤进行回顾性分析,其中卵巢上皮性癌16例,原发腹膜癌2例。结果 8例(44.4％)在初次手术中完成结肠、直肠手术,10例(55.6％)在处理复发性癌或者姑息性手术中进行。18例中接受结肠切除或者部分乙状结肠直肠手术,肠吻合术14例,其中3例手法吻合和11例吻合器吻合;4例接受结肠造瘘术患者中,1例于造瘘术后14个月行结肠造瘘还纳术。手术并发症为发热6例,腹泻3例,伤口延期愈合2例以及1例于术后49d因肿瘤进展和突发急性心肌梗塞死亡。17/18例切除肠管者术后病理示肿瘤侵犯至肠浆膜层7例,至浆肌层5例,至粘膜下层3例,至粘膜层2例。7例术后残留癌<2cm,10例>2cm,1例行姑息性手术未切除肠管。术后1年生存率为76％,2年为29％,3年为19％。2例术后存活已超过5年。结论 对卵巢上皮性癌或原发性腹膜癌患者实施结肠、直肠手术是为达到肿瘤细胞减灭或者为缓解肠梗阻症状。对可疑卵巢恶性肿瘤患者术前宜作肠道准备,术中尽量选择肠切除、肠吻合,减少结肠造瘘。对于某些妇科恶性肿瘤患者为提高治疗效果行部分肠管切除是值得的。     

Surgical management of intestinal obstruction in ovarian cancer. I. Clinical features, postoperative complications, and survival

The results of surgery to relieve intestinal obstruction in 49 patients who were known to have ovarian cancer were studied. All patients had received adjunctive chemotherapy and/or radiation therapy prior to bowel obstruction. Thirty patients had small bowel obstruction, 16 patients had colonic obstruction, and 3 patients had concurrent small and large bowel obstruction. Clinical status, nutritional parameters, and radiographic findings were analyzed. Progressive ovarian cancer was ultimately found to be the cause of obstruction in 86% of patients. Major postoperative complications occurred in 49% of patients and were encountered significantly more frequently in those patients with small bowel obstruction (P less than 0.04). Complications most frequently encountered included wound infection, enterocutaneous fistulae, and other septic sequelae. Median postoperative survival was 140 days, with 73% surviving at 60 days postoperatively. A total of 14.3% of patients were alive 12 months postoperatively. These results are similar to prior reports and emphasize the need for clearer preoperative selection criteria.     

Early enteral feeding following major abdominal surgery for recurrent gynaecological cancer.

We studied the safety of early postoperative enteral feeding in 22 patients with recurrent gynaecological cancer who underwent major abdominal surgery including extensive adhesiolysis, bowel resection and bowel anastomosis. A total of 19 patients (86.4%) had been treated by both radical surgery and radiation therapy with curative intent. In 18 cases (81.8%), the indication for surgery was bowel obstruction. Preoperative total parenteral nutrition (TPN) was not used. Enteral feeding was given through a gastrostomy tube or a jejunal feeding tube and was commenced within 72 h of completion of surgery. The age range was 30-78 years with a median of 52.8 years. A total of 13 patients (59.1%) had a bowel resection and 17 patients (77.3%) had a bowel anastomosis, all stapled. The median maximum tolerated full strength feeding was 50 ml/h for 18-20 h in a 24 h period and maintained for a median of 9 days. In six patients the feeding was interrupted but was re-commenced in five, in four of whom there was no further interruption of feeding. There were no anastomotic leaks and no cases of aspiration. Postoperative enteral feeding was safe in patients with recurrent gynaecological cancer who had undergone major abdominal surgery and should be considered as an alternative to TPN.     

Small bowel incarceration in the umbilical artery following total laparoscopic radical hysterectomy

Total laparoscopic radical hysterectomy (TLRH) has demonstrated to be a feasible and safe technique for patients affected of early cervical cancer. Small bowel obstruction resulting from a loop volvulus represents a very uncommon postoperative complication in gynecological laparoscopic surgery. We report a case of a patient who presented an intestinal obstruction following a TLRH for cervical cancer. The obstruction was caused by entrapment of a segment of small bowel under the dissected obliterated umbilical artery resulting in a loop incarceration. Wide radical pelvic dissection in radical hysterectomy usually leaves uncovered many dissected retroperitoneal structures. Postoperative bands and adhesions represent the main cause of bowel obstruction after a surgical procedure. Retroperitoneal vessel dissection is mandatory to achieve safely an adequate radicality, but it may lead to intestinal complications that should be taken into account. To our knowledge, this is the first report of postoperative bowel incarceration through the umbilical artery after a laparoscopic oncological procedure.