Laparoscopic management of internal hernia of small intestine through a broad ligament defect. J Minim Invasive Gynecol. 2012;19:122-124. [PMID: 22196261 DOI: 10.1016/j.jmig.2011.09.001]

Case report: Emergency management of unilateral herniation of bowel and a bilateral defect of the broad ligament in a resource limited setting

INTRODUCTION

Broad ligament herniation is a rare type of internal hernia, presenting as a diagnostic challenge. An exploratory laparotomy can be performed to definitively diagnose and treat the defect.

CASE PRESENTATION

A 36-year-old female, with no known comorbids and no significant past medical and surgical history presented with acute abdominal pain, multiple episodes of vomiting, and absolute constipation. After clinical and radiologic investigations, the diagnosis of an internal herniation of small bowel to the broad ligament was suspected. An emergent exploratory laparotomy was then performed. Intra-operatively it was found that she had a bilateral defect to the broad ligament and a unilateral broad ligament hernia (BLH). Postoperatively she remained vitally stable and was discharged home.

CLINICAL DISCUSSION

We report a rare case of a unilateral broad ligament hernia with a bilateral defect. Diagnosis of BLH is associated with diagnostic uncertainty mainly due to its rarity and nonspecific presentation.

CONCLUSION

Although broad ligament herniation is rare, it is a significant cause of intestinal obstruction and may result in complications if not attended to timely. Early diagnosis and management is necessary to minimize associated morbidity and mortality that can occur as a consequence of bowel ischemia and necrosis.

Herniation Through Defects in the Broad Ligament

Background

We sought to assess hernia characteristics and classification through comprehensive review of the literature involving broad ligament herniation.

Methods

A literature search via MEDLINE and Embase databases was conducted to identify and select broad ligament herniation studies published between January 1, 2000 and September 30, 2020. Extracted data included previous surgical history, previous obstetric history, diagnostic imaging, herniated organ, hernia classification, and repair performed. The reported data has been compared to a unique case of broad ligament herniation that presented to our institution.

Results

A total of 44 articles with 49 cases were identified for the study. Eighteen (36.7%) patients had a history of previous abdominal surgery while 29 (59.2%) had a history of previous childbirth. Type I (51.0%) and Type II (18.4%) defects were most commonly reported with most patients reporting only one defect (85.7%) using the Cilley classification. Twenty-nine patients underwent primary laparoscopic repair of the defect while 19 patients underwent exploratory laparotomy.

Conclusions

The analysis of previously reported cases adds to the limited literature on broad ligament hernias and highlights the surgical management of this uncommon pathology. It also highlights the need for a broad differential diagnosis when female patients present with pelvic pain or symptoms of small bowel obstruction. The broad ligament should be fully inspected when mesenteric defects are suspected as multiple defects can be present as evidenced by the attached case study.

Herniation of the broad ligament… And the other side?

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

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Discuss the appropriate management of internal hernia.

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

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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.

Broad ligament hernia successfully repaired by single-incision laparoscopy: A case report

A 52-year-old woman with a history of two parturitions presented with lower abdominal pain. Multi-detector CT of the abdomen showed discontinuity of the sigmoid colon near the broad ligament on the left side. We assigned a provisional diagnosis of an internal hernia progressing through a defect in the broad ligament. SILS revealed a total broad ligament defect on the left side but no signs of ischemic, necrotic bowel. We successfully repaired the broad ligament defect with suturing. At the 2-month follow-up, the patient remained well with no signs of recurrence. This case appears to be the first report of a broad ligament hernia successfully diagnosed and repaired by SILS.

The complicated Allen-Masters syndrome: small bowel herniation through a broad ligament defect

Small bowel obstruction through a broad ligament defect is a very rare condition. We present 2 cases, one without any associated abdominal trauma. Rapid diagnosis and treatment of this rare condition is of paramount importance.

Laparoscopic repair of a small bowel herniation through a broad ligament defect

A 44-year-old female presented with a diagnosis of intestinal obstruction from unknown origin. Laparoscopy revealed herniation of small bowel trough a defect in the left broad ligament. After reduction, the defect was corrected laparoscopically. The post operative recovery was uneventful.

Small bowel obstruction caused by an incarcerated intraperitoneal hernia through the vesicouterine pouch: A case report

Intraperitoneal hernia is an uncommon acute abdominal disease that often manifests as an acute intestinal obstruction of small bowel loops that develops through normal or abnormal apertures. According to the anatomic structures, intraperitoneal hernia can be divided into many types. An incarcerated intraperitoneal hernia through the vesicouterine pouch is rarely seen. Here we report a case of incarcerated intraperitoneal hernia through the vesicouterine pouch in a 35-year-old female who presented to our hospital with severe lower abdominal cramps for 2 hours. Abdominal color ultrasound and CT scans showed dilated and fluid-filled small bowel loops. A cluster of dilated bowel loops was located in front of the uterine and behind the bladder. An emergency laparotomy was then performed. Approximately 50 cm of the small intestine, located 40 cm from the ileocecal valve, was found to be herniated through the vesicouterine pouch. Since no circulatory disorder was noted in the incarcerated intestine, only enterolysis was performed without enterectomy. Our case suggests that ultrasound and CT can help not only detect the cause of small bowel obstruction but also facilitate the diagnosis of a variety of internal hernias.