Document Type : Case Report

Authors

1 University College London, London, UK

2 General Surgery Department, Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals, Doncaster, UK

3 General Surgery Department, Frimley Park Hospitals, Surrey, UK

4 General Surgery Department, Kings College Hospitals, PRUH, London, UK

Abstract

Introduction: Broad ligament hernia was first reported post-autopsy by Quain in 1861. In a 1995 review article, only 61 cases had ever been reported. This paper presents a case report of broad ligament hernia and explores the literature surrounding this topic.
Case Presentation: The patient presented with no significant past medical history, acute lower abdominal pain (several hours), nausea, and vomiting. Clinical examination showed a heart rate of 85 beats per minute; normal temperature, blood pressure, and respiratory rate; and a mildly distended abdomen with tenderness across the right lower quadrant. A plain abdominal X-ray showed dilated small bowel loops, and a blood test showed leukocytosis. Urgent diagnostic laparoscopy showed a broad ligament strangulated hernia with small bowel infarction. Reduction of the small bowel, resection, and side-side anastomosis were performed. The patient had an uneventful recovery, and follow up reported no postoperative complications.
Conclusion: Laparoscopic management of small bowel obstruction due to broad ligament internal hernia is a safe and effective option.

Keywords

  1. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol. 2006;186(3):703-717. doi:10.2214/AJR.05.0644.
  2. Fafet P, Souiri M, Ould Said H, Mattei M, Godlewski G. [Internal hernia of the small intestine through a breach of the broad ligament, apropos of a case. Review of the literature]. J Chir (Paris). 1995;132(6-7):314-317.
  3. Langan RC, Holzman K, Coblentz M. Strangulated hernia through a defect in the broad ligament: a sheep in wolf’s clothing. Hernia. 2012;16(4):481-483. doi:10.1007/s10029-010-0761-1.
  4. Marraoui W, Petitcolin V, Bros S, Slim K, Garcier JM, Da Ines D. Internal hernia of the broad ligament: CT diagnosis for laparoscopic management. Diagn Interv Imaging. 2012;93(7- 8):621-624. doi:10.1016/j.diii.2012.03.016.
  5. Guillem P, Cordonnier C, Bounoua F, Adams P, Duval G. Small bowel incarceration in a broad ligament defect. Surg Endosc. 2003;17(1):161-162. doi:10.1007/s00464-002-4228-z.
  6. Tavangari FR, Batech M, Collins JC, Tejirian T. Small bowel obstructions in a virgin abdomen: is an operation mandatory? Am Surg. 2016;82(10):1038-1042.
  7. Beardsley C, Furtado R, Mosse C, et al. Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. Am J Surg. 2014;208(2):243-248. doi:10.1016/j.amjsurg.2013.09.034.
  8. Ismael H, Ragoza Y, Cox S. Intestinal stenosis of Garre: A rare cause of small bowel obstruction in the virgin abdomen. Int J Surg Case Rep. 2016;25:156-160. doi:10.1016/j.ijscr.2016.06.005.
  9. Nasri B, Calin M, Shah A, Gilchrist B. A rare cause of small bowel obstruction due to bezoar in a virgin abdomen. Int J Surg Case Rep. 2016;19:144-146. doi:10.1016/j.ijscr.2015.12.039.
  10. Sankey RE, Maatouk M, Mahmood A, Raja M. Case Report: Jejunal gastrointestinal stromal tumour, a rare tumour, with a challenging diagnosis and a successful treatment. J Surg Case Rep. 2015;2015(5). doi:10.1093/jscr/rjv050.
  11. Ooi S, Hong K. Small bowel obstruction caused by dried apple. Int J Surg Case Rep. 2015;10:154-157. doi:10.1016/j.ijscr.2015.03.038.
  12. Agresta F, Michelet I, Candiotto E, Bedin N. Incarcerated internal hernia of the small intestine through a breach of the broad ligament: two cases and a literature review. JSLS. 2007;11(2):255- 257.
  13. Vo TM, Gyaneshwar R, Mayer C. Concurrent sigmoid volvulus and herniation through broad ligament defect during pregnancy: case report and literature review. J Obstet Gynaecol Res. 2008;34(4 Pt 2):658-662. doi:10.1111/j.1447-0756.2008.00903.x.
  14. Matsunami M, Kusanagi H, Hayashi K, Yamada S, Kano N. Broad ligament hernia successfully treated by laparoscopy: Case report and review of literature. Asian J Endosc Surg. 2014;7(4):327-329. doi:10.1111/ases.12119.
  15. Talebpour M, Habibi GR, Bandarian F. Laparoscopic management of an internal double omental hernia: a rare cause of intestinal obstruction. Hernia. 2005;9(2):195-197. doi:10.1007/s10029-004-0288-4.