main causes of bowel obstructions are postoperative adhesions , second leading causes are malignant tumors or strictures of the small bowel , followed by hernias . 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 . 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 crest ( figure 1 ) .   during laparoscopy , the small bowel had herniated directly below the cecal pole through the peritoneum ( figures 2 , and 3 ) . due to collateral circulation in the peritoneum and cecum caused by portal hypertension , an intraperitoneal onlay - mesh repair could not be performed . after the trocars were removed , the wound at the right iliac crest was reopened . then , a dynamesh of 12  13  cm was fixed with single sutures . after returning to a normal diet and an uneventful recovery , hernia symptoms range from a palpable lump in the groin or abdomen , pain , and tenderness , to nausea and vomiting when obstruction occurs . in most cases , since the iliac crest has become a common donor site for autogenous bone graft , numbers of postsurgical inferior lumbar hernias are rising . the incidence varies between 59% as shown in previous reports [ 3 , 4 ] . other reported complications are nerve and ureteral injury , arterial injury , fracture , pelvic instability , herniation , ileus , and hematoma . due to the increased morbidity and mortality associated with these defects , it can be accomplished through laparoscopic , retroperitoneal or transabdominal approach . the first laparoscopic repair of lumbar hernia was described in 1996 by burick and parascandola . other techniques include soft tissue transfers to bridge the gap of the abdominal wall defect ( transversalis fascia , abdominal musculature , and tensor fascia lata ) or the bosworth repair ( the anterior superior iliac spine is moved inferiorly and posteriorly , so muscles and fascia cover the defect ) . a new corkscrew anchor system has been described by patten et al . to place sutures in the postharvest iliac crest remnant . as described , we repaired the extraperitoneal hernia after iliac crest bone harvest with an onlay mesh . if symptoms of bowel obstruction occur after an iliac bone crest harvest , it is important to think of a hernia . while removing the iliac bone crest , verification of an intact peritoneum is important . a laparoscopic repair should be performed if possible , as it has proved to be safe for the repair of hernias through the inferior lumbar triangle [ 9 , 10 ] .
the iliac crest has become an often used site for autogenous bone graft , because of the easy access it affords . 
 one of the less common complications that can occur after removal is a graft - site hernia . 
 it was first reported in 1945 ( see the work by oldfield , 1945 ) . 
 we report a case of iliac crest bone hernia in a 53-year - old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side . 
 one and a half months after initial surgery , the patient presented with increasing abdominal pain and signs of bowel obstruction . a ct scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest . 
 a laparoscopy showed a herniation of the small bowel . due to collateral vessels of the peritoneum caused by portal hypertension , an ipom ( intraperitoneal onlay - mesh ) 
 occlusion could not be performed . 
 we performed a conventional ventral hernia repair with an onlay mesh . 
 the recovery was uneventful .