Nigerian Journal of Clinical Practice

CASE REPORT
Year
: 2021  |  Volume : 24  |  Issue : 12  |  Page : 1855--1858

Mechanic ileus due to retroperitoneal migration of total hip prosthesis; A case report


SF Ocak Karatas1, M Beyhan2, MI Yildiz3, E Gokce2,  
1 Department of Radiology, Tokat State Hospital, Tokat, Turkey
2 Department of Radiology, Tokat Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
3 Department of General Surgery, Tokat State Hospital, Tokat, Turkey

Correspondence Address:
Dr. S F Ocak Karatas
Department of Radiology, Tokat State Hospital, Tokat
Turkey

Abstract

Intrapelvic migration of total hip prosthesis is a rare but severe complication of total hip arthroplasty that can cause severe outcomes for elderly patients. A 78-year-old female patient was referred to our hospital with the complaint of no gas-stool excretion for 3-4 days, abdominal distension, nausea, vomiting, and a preliminary diagnosis of ileus. Computed tomography showed the migration of the left total hip prosthesis to the pelvis, causing a hematoma around the prosthesis and mechanical ileus due to the compression of the hematoma. To our knowledge, this case report is the only reported mechanic ileus due to migration of total hip prosthesis. Although postop paralytic ileus is one of the complications of total hip arthroplasty, mechanical ileus has not been described before. This case report shows that mechanical ileus might be an unreported complication of total hip arthroplasty. It should be kept in mind that mechanical ileus complications may also occur after hip arthroplasty.



How to cite this article:
Ocak Karatas S F, Beyhan M, Yildiz M I, Gokce E. Mechanic ileus due to retroperitoneal migration of total hip prosthesis; A case report.Niger J Clin Pract 2021;24:1855-1858


How to cite this URL:
Ocak Karatas S F, Beyhan M, Yildiz M I, Gokce E. Mechanic ileus due to retroperitoneal migration of total hip prosthesis; A case report. Niger J Clin Pract [serial online] 2021 [cited 2022 Sep 26 ];24:1855-1858
Available from: https://www.njcponline.com/text.asp?2021/24/12/1855/332088


Full Text



 Introduction



Hip arthroplasty is one of the most common orthopedic procedures performed for pain relief, restoration of function, and improved quality of life, allowing early weight-bearing and mobilization.[1] There are two main types of hip arthroplasty; hemiarthroplasty and total arthroplasty. Hemiarthroplasty is the replacement of only the femoral component of the hip joint

Total hip arthroplasty (THA), which replaces acetabulum as well as femoral head and neck,[1] is considered as “the operation of the century” in 2007 by Lancet.[2]

Although THA is generally a safe and predictable operation, some rare complications have been reported, such as intrapelvic prosthesis migration.[3] The migration of the total hip prosthesis usually occurs secondary to the medial acetabular wall defect and can cause various intrapelvic complications.[4] As far as we know, this case is the first report that presents mechanic ileus due to migration of the total hip prosthesis.

 Case Presentation



A 78-year-old female patient was transferred from an external center to the state hospital's emergency room for consultation with suspicion of ileus. The patient had an operation ten years earlier for a left total hip replacement. It had been revised five years after, and the last hospital visit of the patient due to prosthetic dislocation was eight months ago. The patient stated that there was no gas-stool excretion for 3-4 days. Physical examination showed that the voluntary defense was present, and bowel sounds were hypokinetic. The patient had no fever, and her vital signs were stable. The patient complained of nausea and vomiting. Apart from ileus, the patient also had symptoms of mild pneumonia.

On computed tomography (CT), the left hip joint was found dislocated, and the acetabular cup, femoral head, and fixing screw were moved to the pelvis. The acetabular cup was separated from the other part of the prosthesis [Figure 1]. There was a displaced fracture in the left acetabulum and iliac wing. A semisolid mass, which was considered a hematoma, was observed around the hip prosthesis. The mass was found to be extended to the retroperitoneal area, the anterior abdominal wall, and the left upper quadrant, causing the pushing of the anterior abdominal wall [Figure 2]. The small intestine and proximal colonic anses were found dilated. The erect abdominal x-ray verified that [Figure 3]. Distal colonic anses were collapsed. The patient had a previous CT scanning, and no ileus findings were visible in the last CT examination.{Figure 1}{Figure 2}{Figure 3}

The examination of the CT images and the patient's medical history revealed the patient's present pathology occurred after repeated operations with prosthesis dislocation. However, since there was no gas-stool excretion for 3-4 days, the general surgeon recommended hospitalization in terms of ileus' etiology. The patient was hospitalized in the orthopedic clinic and was observed by the general surgeon. On 3rd day of hospitalization, an increase in abdominal distension was observed, and an operation was planned for the patient to decompress the bowel loops. In the intraoperative examination, the dislocation of the prosthesis was observed. The dislocation caused hematoma, which was in the retroperitoneal area and extending to the spleen level. The distal ½ part of the transverse colon and descending colon were exposed to pressure between the abdomen's anterior wall and the hematoma, and there was no passage. Loop ileostomy was performed, and the operation was terminated successfully. However, the patient who had preoperative signs of pneumonia died one day later due to anesthesia complications.

 Discussion



Osteoarthritis is a major health issue in elderly patients, and THA is a good treatment option in treating symptomatic hip joint osteoarthritis.[5] There are some complications associated with the THA procedure which standardized by The Hip Society as; bleeding, thromboembolic disease, neural deficit, dislocation/instability, periprosthetic fracture, wound complication, abductor muscle disruption, deep periprosthetic joint infection, heterotopic ossification, vascular injury, bearing surface wear, implant loosening, cup liner dissociation, osteolysis, implant fracture, revision, reoperation, readmission, and death.[2]

THA may fail and may require revision.[6] One of the main reasons for THA revision is the dislocation of the hip prosthesis.[7] After THA revision, complications such as infection, redo revision, venous thromboembolic disease, dislocation, pulmonary emboli, and death can be seen.[8] Furthermore, intrapelvic prosthesis migration is another serious THA complication, causing further life-threatening complications of its own. Revision of intrapelvic material has potentially lethal complications[3] as well as may damage the sciatic and obturator nerves and pelvic organs.[9] While the external iliac artery and bladder are most often affected, the most common types of complications are fistula formation, pseudoaneurysm, and bleeding.[10]

Gastrointestinal system complications after THA are rare. The most common gastrointestinal system complication is fistula formation.[10] Fistulas have been described between the hip and the rectum or the sigmoid colon in the literature.[11] Also, postoperative paralytic ileus (POI) was described as an infrequent THA complication.[12] Parvizi et al. reported that POI incidence after the lower extremity reconstruction range is between 0.3%-4.0%. Additionally, after THA revision, the incidence of POI is 5.6%.[12] Furthermore, mechanical ileus due to hip prosthesis migration has never been described in the previous reports.

In a 50-case literature review by Bach et al. on post-THA intrapelvic migration, the components that threatened vital organs were cement and screws (33 cases) more often than the cup (17 cases). Fifty patients had 22 vascular, 17 urogenital, 13 bladder, six digestive system, three sciatic nerve, and two iliopsoas muscle complications.[10]

Ileus is an obstruction or paralysis of the bowel which prevents the downward passage of intestinal contents and causes their accumulation in the proximal part.[13] Mechanical intestinal obstruction occurs when a physical barrier blocks intestinal flow, while paralytic ileus is a functional disorder of the intestinal wall or nervous system.[14]

In our case, THA migrated to the intraperitoneal area and caused a hematoma, which was verified by a CT scan. Hematoma constituted a physical barrier resulting in a mechanical ileus. The complications' diagnosis is based on the radiographic evaluation, which is still a mainstay for long-term follow-up. However, radiographs have their shortcomings, and relatively new imaging techniques such as CT, magnetic resonance imaging, and bone scintigraphy were reported in the literature.[15],[16] In the present case, two CT scans examined at different times facilitated the diagnosis of the hematoma.

 Conclusion



Intrapelvic prosthesis migration is a severe complication of THA. Although postoperative paralytic ileus associated with THA have been identified, as far as we know, mechanical ileus has never been identified in the literature. It should be kept in mind that mechanic ileus may also be one of the complications of THA.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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