Early Mechanical Small Bowel Obstruction Caused by Focal Entrapment Around Non-Migrated Hem-O-Lok Clips on the Inferior Mesenteric Vessel Stump Following Laparoscopic Low Anterior Resection: A Case Report and Focused Literature Review

Small bowel obstruction (SBO) is a recognized complication after colorectal surgery. We report an early postoperative mechanical SBO caused by non-migrated Hem-O-Lok clips after laparoscopic low anterior resection (LAR). A 65-year-old man presented eight days after laparoscopic LAR with recurrent vomiting and obstipation. Examination showed abdominal distension, decreased bowel sounds, tympany, and minimal tenderness without peritoneal signs. Computed tomography (CT) demonstrated dilated small-bowel loops and a discrete transition point without radiological features of ischemia, necrosis, or perforation. Because the patient remained clinically stable and no urgent operative indication was identified, a monitored trial of non-operative management was undertaken with nasogastric decompression, bowel rest, serial abdominal examinations, and interval imaging. Persistent obstruction, failed contrast progression, an unchanged transition point, and increasing bowel dilatation prompted reoperation on hospital day five. Exploratory laparotomy demonstrated a band-like tethering point involving Hem-O-Lok clips that remained attached to the inferior mesenteric vessel stump and entrapped a small-bowel loop. The clips were removed, the vascular stump was secured with Vicryl sutures, and the obstruction resolved. The patient recovered without postoperative complications and was discharged on postoperative day four. Unlike previously reported colorectal cases in which clips dislodged and became embedded in the small-bowel wall, the clips in this case remained attached to the inferior mesenteric vessel stump and produced extrinsic focal entrapment. The histological nature of the band-like tissue could not be established because no specimen was obtained. This case illustrates that clip-related obstruction can occur without migration and that CT may not establish the clip-bowel relationship. Its clinical contribution is to draw attention to the clipped vascular pedicle during exploration of persistent focal SBO and to the need to consider vascular control when releasing the entrapped bowel.