Defect in the broad ligament and its association with intestinal strangulation

Holes can be perilous: A rare presentation of intestinal obstruction - Herniation through the broad ligament

A 57-year-old lady presented with symptoms of intestinal obstruction preceded by a 2-day history of lower abdomen pain. Clinically, she had a distended abdomen with tenderness in her lower abdomen. Laboratory investigations were unremarkable. An abdominal radiograph showed a dilated small bowel with no extensive bowel gas. A computed tomography (CT) scan showed suspected intestinal obstruction secondary to herniation into the right broad ligament. The decision was made to proceed with surgery, and the intraoperative results confirmed the CT results. The literature review is outlined here, and this instance illustrates a surprising discovery.

Usefulness of early diagnosis of small bowel obstruction due to broad ligament hernia using multidetector computed tomography: a case report

Small bowel obstruction due to broad ligament hernia (BLH) is a rare type of internal hernia. Preoperative diagnosis is difficult, as clinical symptoms and imaging results are often nonspecific. BLH has a high risk of strangulation and requires surgery for the reduction of herniated bowels. According to an analysis of 140 BLH cases reported in Japan, the typical patient is a middle-aged woman who has been pregnant and has no history of abdominal surgery and the characteristic computed tomography (CT) findings. This report will enable preoperative early diagnosis with our description of the typical patient with BLH and the characteristic CT findings. Tortuousness and dilation of the ovarian veins were noted in three cases, including in ours. This may be used as a new CT feature of early detection. Additionally, we report a case of BLH successfully treated after early diagnosis using multidetector CT.

Herniation of the broad ligament… And the other side?

•

Internal hernia is a classical cause of small bowel obstruction but remains rare.

•

Discuss the appropriate management of internal hernia.

•

Broad ligament hernias account for less than 5% of internal hernia.

•

When performing surgery for broad ligament hernia, consider looking for contralateral hernia.

Introduction

Broad ligament herniation is a very uncommon cause of small bowel obstruction. Surgery permits reduction of the hernia and closure of the defect to prevent recurrence.

Presentation of case

We report a rare case of a 35 year old woman admitted in our hospital for recurrence of a small-bowel obstruction, secondary to internal hernia. The patient underwent intestinal resection in 2018 for herniated left broad ligament of the uterus strangulated.

This time, the computed tomography revealed a double junctional syndrome with ileal dilation localized in right side of uterus. Emergency surgery confirmed internal hernia with passage of ileal loops through the right broad ligament. After reduction of the hernia, closure of the defect was performed to prevent recurrence. For the first time, a check of other classic abdominal hernias was carried out.

Discussion

Internal hernias are responsible for less than 5% of mechanical bowel obstruction. Broad ligament hernias represent only 4–7% of these hernias.

The diagnosis is often delayed, because of its rarity and lack of surgical history. Surgery confirms the diagnosis, treats the occlusion and prevents recurrence.

The presence of several internal hernias has never been studied and no recommendation has been made on this topic.

Conclusion

This case demonstrate the importance of a systematic exploration of other internal abdominal hernias during the surgery, especially a contralateral broad ligament hernia.

Acute abdominal pain due to internal herniation of the sigmoid colon, fallopian tube and left ovary, a rare presentation of Allen Masters syndrome

In 1955, Allen and Masters describe a painful syndrome which associates traumatic delivery to laceration found on the posterior leaf of the broad ligament. Herniation through this defect is a rare entity, accounted for about 4-7% of all internal hernias. Normally, it involves the small bowel. The authors present the case of a multiparous woman admitted at emergency for constipation and abdominal pain. The CT scan showed an extremely rare case of internal hernia of the sigmoid colon, fallopian tube and left ovary through a large defect of the broad ligament. The patient underwent a full laparoscopic surgery that allowed the reduction of the hernia and the suture of the defect with very good outcome.

Broad ligament hernia successfully treated by laparoscopy: Case report and review of literature

We report a case of a 36-year-old woman with a history of caesarean section who presented with small bowel obstruction. Abdominal multi-detector CT showed discontinuity of the small bowel near the broad ligament on the left. We made a provisional diagnosis of an internal hernia through a defect in the broad ligament and performed laparoscopic exploration, which revealed a viable ileal loop incarcerated by the broad ligament. Multi-detector CT may be useful for diagnosing this type of defect preoperatively, whereby open surgery can be avoided.

Radiologic imaging of herniation of the small bowel through a defect in the broad ligament

Internal herniation through the broad ligament is extremely rare. We report a case in which radiologic examinations including computed tomography (CT) were performed. A strangulated loop in the Douglas fossa was well-demonstrated by CT. CT can provide some clues to the diagnosis of this condition.

Bowel herniation through a defect of the broad ligament

This is the fifty-fourth reported case of a defect in the broad ligament and the forty-ninth associated with intestinal obstruction.

Ileovaginal fistula complicating internal hernial strangulation through a broad ligament defect

The causes of ileovaginal fistula are discusse.

A case of ileovaginal fistula due to incrceration of ileum in a broad ligament defect is presented and the anatomy and aetiology of broad ligament pouches and foramina are discussed.