Published: 2020-05-26

Closed loop small bowel obstruction due to mid urethral sling mesh

Marwan Alaoudi, Bhavana Devanabanda, Roland Haj, Martine Louis, Darshak Shah


Closed loop small bowel obstruction is a surgical emergency, which when left untreated leads to vascular compromise resulting in intestinal ischemia, necrosis and perforation. We report the case of a 61 years old female with past surgical history of hysterectomy and a mid-urethral sling, who presented to the emergency department for abdominal pain and obstipation. She was found on imaging to have a closed loop small bowel obstruction. An exploratory laparotomy revealed an adhesive band encompassing the distal terminal ileum, visceral peritoneum and the Mid‐urethral slings mesh. This is a rare complication that, to our knowledge, has not been reported in the surgical literature. This paper will discuss the clinical presentation, diagnostic studies, therapeutic intervention and outcome of this unique case.


Closed loop small bowel obstruction, Mid urethral sling mesh, Adhesion, Retropubic space, Intraperitoneal, Extraperitoneal

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Reddy SRR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017;19(6):28.

Mbengue A, Ndiaye A, Soko T. Closed loop obstruction: Pictorial essay. Diagn Interv Imaging. 2015;96(2):213-20.

Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database of Syst Rev. 2017;7:CD006375.

Stanford EJ, Paraiso MFR. A Comprehensive Review of Sub-urethral Sling Procedure Complications. J Minim Invasive Gynecol. 2008;15(2):132-45.

Champion JK, Williams M. Small Bowel Obstruction and Internal Hernias after Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg. 2003;13(4):596-600.

Barbiera F, Ciraulo R, Cusma S, Pardo S, Casto LA. Closed loop intestinal obstruction: role of computerized tomography. Radiol Med. 1999;97(1-2):54-9.

Derikx JP. Non-invasive markers of gut wall integrity in health and disease. World J Gastroenterol. 2010;16(42):5272-9.

Okabayashi K, Ashrafian H, Zacharakis E. Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today. 2014;44(3):405-20.

Mullan CP, Siewert B, Eisenberg RL. Small Bowel Obstruction. AJR Am J Roentgenology. 2012;198(2):105-17.

Thompson WM. Gasless Abdomen in the Adult. AJR Am J Roentgenology. 2008;191(4):1093-9.

Makar RA, Bashir MR, Haystead CM. Diagnostic performance of MDCT in identifying closed loop small bowel obstruction. Abdom Radiol. 2016;41(7):1253-60.

Bruggmann D, Tchartchian G, Wallwiener M, Munstedt K, Tinneberg HR, Hackethal A. Intra-abdominal Adhesions. Dtsch Arztebl Int. 2010;107(44):769-75.

Almeida SH, Brandina R, Aqua DV. Small-bowel obstruction and bladder injury due to retropubic sling malposition in the peritoneal cavity. Int Urogynecol J. 2013;24(8):1411-2.

Cohen SA, Goldman HB. Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery-Presentation and Management. Curr Urol Rep. 2016;17(9):64.