High Grade Intestinal Obstruction From Internal Hernia Beneath an Intraperitoneal External Iliac Artery.

Acute small bowel obstruction (SBO) is a common cause of emergency department visits in the United States, and it accounts for approximately 20% of emergency surgical operations.1 Its etiology is divided into intrinsic luminal obstruction or extrinsic compression of the bowel.2 Among the causes of SBO, by far the most common is intraperitoneal adhesions due to previous abdominal surgeries, which comprises about 60-70% of the cases.2 The abdominal cavity is subdivided into the peritoneal cavity and the retroperitoneal cavity; the division is marked by a thin covering of parietal peritoneum that encases all the intraperitoneal structures. Here, we present a rare case of an acute small bowel obstruction secondary to exposure of the retroperitoneal external iliac artery from a surgical procedure 20 years prior to presentation.