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Recommended by G. Cherr
Department of Visceral Surgery, University of Basel, 4031 Basel, Switzerland
Received 23 February 2011; Accepted 22 March 2011
1. Background
Main causes of bowel obstructions are postoperative adhesions, second leading causes are malignant tumors or strictures of the small bowel, followed by hernias [1]. Intussusception, volvulus, Crohn's disease, and gallstones (gallstone ileus) account for only a small percentage of cases. Since the iliac crest has become an often used site for autogenous bone graft, one of the rare complications is a graft site hernia.
2. Case Presentation
A 53-year-old man was admitted for the elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. The patient also suffered from liver cirrhosis Child B and thrombosis of the portal vein due to infection with hepatitis C and alcohol abuse. A hepatocellular carcinoma was diagnosed in a liver biopsy performed during hospitalisation.
At the right iliac crest bone harvest point, two fragments of artificial bone, which had been inserted for stabilisation, subsequently dislocated. Because of the patient's limited health, there was no immediate removal of the dislocated fragments.
In the course of further hospitalisation, the patient complained of increasing abdominal pain and showed signs of bowel obstruction. A lump on the right iliac crest could be palpated, and bowel movement was auscultated. A CT of the abdomen confirmed an obstruction of the small bowel caused by the herniation of the ileum into the the bone defect in the right iliac...