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MacDonald S, Stokes E, Macdonald A, Sharaf U. Quain hernia - A rare cause of acute small bowel obstruction. A case report and an updated literature review. Int J Surg Case Rep 2021; 89:106599. [PMID: 34794072 PMCID: PMC8605219 DOI: 10.1016/j.ijscr.2021.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction and importance Internal herniae are a rare cause of acute small bowel obstruction (SBO), accounting for <1% of all causes of SBO. Given their low incidence and often vague presenting symptoms there can be a delay in their diagnosis - which can lead to unnecessary morbidity for patients. Case presentation We present a case of a 34 year-old nulliparous female who presented with acute abdominal pain and transpired to have a closed loop obstruction of her ileum through a congenital defect in her broad ligament, or a Quain hernia. Discussion This paper will describe this case and provide an updated literature review of Quain herniae from recent research. With regards to surgical management of these hernia, both laparoscopic and open approaches are appropriate as long as appropriately trained surgical staff are involved. If a contraltateral defect in the Broad ligament is identified, this should be repaired prophylactically at the time in order to prevent future instances of internal herniation. Conclusion Increased awareness of the potential presenting symptoms and radiological features of Quain hernia, as outlined in this paper, is vital in order to reduce patient morbidity and mortality. Quain hernia is a subtype of internal hernia caused by a defect in the broad ligament. Their lack of recognition often leads to a delayed diagnosis and increased patient morbidity. Both open and laparoscopic repair are suitable in appropriately trained individuals. Contralateral defects should be fixed prophylactically to prevent future herniation.
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Affiliation(s)
- Scott MacDonald
- Department of Surgery, University Hospital Monklands, NHS Lanarkshire, Monkscourt Avenue, Airdrie, Scotland ML6 0JS, United Kingdom of Great Britain and Northern Ireland.
| | - Emily Stokes
- Department of Surgery, University Hospital Monklands, NHS Lanarkshire, Monkscourt Avenue, Airdrie, Scotland ML6 0JS, United Kingdom of Great Britain and Northern Ireland
| | - Angus Macdonald
- Department of Surgery, University Hospital Monklands, NHS Lanarkshire, Monkscourt Avenue, Airdrie, Scotland ML6 0JS, United Kingdom of Great Britain and Northern Ireland
| | - Usama Sharaf
- Department of Surgery, University Hospital Monklands, NHS Lanarkshire, Monkscourt Avenue, Airdrie, Scotland ML6 0JS, United Kingdom of Great Britain and Northern Ireland
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Hasegawa N, Takeyama H, Suzuki Y, Noura S, Odagiri K, Yanagimoto Y, Yamashita M, Shimizu J, Kawase T, Imamura H, Iwazawa T, Tomita N, Dono K. Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report. Surg Case Rep 2021; 7:213. [PMID: 34546429 PMCID: PMC8455758 DOI: 10.1186/s40792-021-01292-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Paraduodenal hernia is a rare internal hernia which accounts for only 1% of all intestinal hernias. There have been limited reported cases of paraduodenal hernia treated by laparoscopic surgery. We report a case of left paraduodenal hernia that was successfully treated by single-incision laparoscopic surgery (SILS). Case presentation A 17-year-old woman presented with left upper abdominal pain. An abdominal enhanced multi-detector computed tomography demonstrated encapsulated cluster of small bowel loops in the left upper quadrant which passed through the dorsal side of the inferior mesenteric vein, and showed that blood flow of the prolapsed small bowel was preserved. We preoperatively diagnosed left paraduodenal hernia without ischemia or necrosis. We performed elective SILS because she was a young actress training school student and cosmetic benefit was thought to be important. We pulled out the protruded small bowel and closed a defect with a running suture by SILS. The patient was discharged 3 days after the surgery with no complications. Conclusions We reported the case of left paraduodenal hernia successfully diagnosed and treated by SILS.
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Affiliation(s)
- Noboru Hasegawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Takeyama
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Shingo Noura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Kazuki Odagiri
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Yoshitomo Yanagimoto
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Masafumi Yamashita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Tomono Kawase
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Iwazawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Naohiro Tomita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
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Pascotto B, Poulain V, Ghistelinck B, Azagra JS. [Covid No-related Surgical Emergencies During COVID-19 Time. Case Report: Broad Ligament Internal Hernia With Associated Small Bowel Necrosis]. Cir Esp 2021; 99:547-549. [PMID: 38620284 PMCID: PMC7334932 DOI: 10.1016/j.ciresp.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Beniamino Pascotto
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxemburgo, Luxemburgo
| | - Virginie Poulain
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxemburgo, Luxemburgo
| | - Barbara Ghistelinck
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxemburgo, Luxemburgo
| | - Juan Santiago Azagra
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxemburgo, Luxemburgo
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Sajan A, Hakmi H, Griepp DW, Sohail AH, Liu H, Halpern D. Herniation Through Defects in the Broad Ligament. JSLS 2021; 25:JSLS.2020.00112. [PMID: 34248336 PMCID: PMC8241289 DOI: 10.4293/jsls.2020.00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Abin Sajan
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Hazim Hakmi
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Daniel W Griepp
- College of Medicine, New York Institute of Technology, Old Westbury, NY
| | - Amir H Sohail
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - Helen Liu
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | - David Halpern
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, NY
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Rohatgi Y, Harvitkar RU, Raut V, Joshi A. Broad ligament hernia: Two contrasting ways to a common goal - Two case reports with review of literature. Int J Surg Case Rep 2021; 85:106198. [PMID: 34304087 PMCID: PMC8327646 DOI: 10.1016/j.ijscr.2021.106198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Broad ligament hernia (BLH) is a rare but potentially life threatening condition. One of the two cases described here is the only reported case of BLH in recent literature, where marsupialisation was done. These two case reports comprise the only reported side by side pictorial comparison of the two laparoscopic surgical therapeutic options for BLH. Presentation of cases Both patients presented with classical symptoms and signs of acute intestinal obstruction. Imaging confirmed obstructed left BLH in case 2 and indicated a complete small bowel obstruction in case 1. Both cases were successfully managed laparoscopically. Both patients had an uneventful immediate postoperative recovery and have not had recurrence over a mean follow up period of 34.5 months. Discussion BLH is rare among all types of internal herniae. It accounts for only 4% of internal herniae and is a difficult condition to diagnose. The advent of computed tomography has increased chances of accurate preoperative diagnosis. Conclusion BLH can be successfully managed by minimally invasive surgery, even in the acute setting. When tightly entrapped bowel is unyielding; it is better not to risk injury to it by aggressive attempts at its reduction. It is safer to attempt widening of the defect into which it is entrapped, whenever feasible. Internal herniae are a rare cause of acute bowel obstruction Among internal herniae, broad ligament hernia is even more uncommon One of the two cases described in this paper is the only reported case of BLH in literature, where marsupialization was done This is the only paper with a pictorial comparison of the two contrasting ways in which this condition can be treated
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Affiliation(s)
- Yash Rohatgi
- Department of General & Laparoscopic surgery, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India.
| | - Rafique Umer Harvitkar
- Department of General & Laparoscopic surgery, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India
| | - Vanita Raut
- Department of Obstetrics & Gynecology, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India.
| | - Abhijit Joshi
- Department of General & Laparoscopic surgery, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India
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Rare Contents of an Internal Hernia through a Defect of the Broad Ligament of the Uterus. Case Rep Surg 2021; 2021:5535162. [PMID: 34194864 PMCID: PMC8181115 DOI: 10.1155/2021/5535162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/23/2021] [Indexed: 12/02/2022] Open
Abstract
Herniation through a defect of the uterine broad ligament is a rare internal hernia that is difficult to diagnose definitively. Common hernia contents contain ileal loops. Herein, we report a rare case of internal herniation of both the ileum and fallopian tube through a defect of the broad ligament. A 52-year-old woman presented to our hospital with suprapubic pain and vomiting. She had a history of bowel obstruction following cesarean section. On abdominopelvic computed tomography, we suspected a closed-loop obstruction associated with bowel herniation in the right broad ligament. However, we could not identify an area of poor enhancement adjacent to distended small intestines. Emergency laparoscopic exploration revealed a viable ileal loop and incarcerated organ. Therefore, we switched to laparotomy that revealed the right fallopian tube as the ischemic organ. We reduced the hernia, resected necrotic right fallopian tube, and closed the defect of the broad ligament. The patient had an uneventful postoperative course. Rare hernia contents might complicate preoperative clinical diagnosis. Laparoscopy is useful for establishing a definitive diagnosis and treating broad ligament hernias.
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Koninckx PR, Ussia A, Keckstein J, Adamyan L, Wattiez A, Martin DC. Prevalence of Endometriosis and Peritoneal Pockets in Women with Infertility and/or Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:935-942. [PMID: 33984522 DOI: 10.1016/j.jogc.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the prevalence of endometriosis and peritoneal pockets and to analyze whether these pockets are associated with pain. METHODS Analysis of prospectively registered data of all women undergoing laparoscopy for infertility or pelvic pain between 1988 and 2011 at KU Leuven University Hospital. RESULTS Of 4497 women, 191 had 238 pockets, with a prevalence of 4.7% in women with infertility only, 4.9% in women with infertility and pelvic pain, and 3.5% in women with pelvic pain only (P = 0.045 for all infertility vs. pelvic pain only). Prevalence did not vary by age. Pockets were associated with endometriosis (P < 0.0001), which was found in 77% of women with pockets. Among women with infertility only, the prevalence of endometriosis was higher in women with pockets (P = 0.0001) than in women without. The prevalence of endometriosis was similar in women with infertility and pelvic pain or pelvic pain only. Pelvic pain as an indication for surgery was associated simultaneously (through logistic regression) with endometriosis (P < 0.0001) and pockets (P = 0.040). Pelvic pain severity was associated simultaneously with pockets (P = 0.0026) and the severity of subtle (P = 0.001), typical (P = 0.030), cystic ovarian (P = 0.051), and deep endometriosis (P < 0.0001). Pelvic pain severity was not associated with endometriosis in the pockets or the diameter or location of pockets. CONCLUSIONS The prevalence of pockets was low, at between 3.5% and 5%. Women with infertility only and pockets had more endometriosis than women without. Severe pelvic pain and pelvic pain as an indication for surgery were associated with the presence of pockets as well as the presence and severity of endometriosis.
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Affiliation(s)
- Philippe R Koninckx
- Latifa Hospital, Dubai, United Arab Emirates; Obstetrics and Gynecology KU Leuven, Bierbeek, Belgium; University of Oxford, United Kingdom; Universita Cattolica, Rome, Italy; Moscow State University, Russia; Gruppo Italo Belga, Rome, Italy.
| | - Anastasia Ussia
- Universita Cattolica, Rome, Italy; Gruppo Italo Belga, Rome, Italy
| | - Jörg Keckstein
- Endometriosis Centre, County Hospital Villach, Austria; University Ulm, Ulm, Germany
| | - Leila Adamyan
- Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov Research Centre for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Arnaud Wattiez
- Latifa Hospital, Dubai, United Arab Emirates; Department of Obstetrics and Gynaecology, University of Strasbourg, France
| | - Dan C Martin
- University of Tennessee Health Science Centre, Memphis, TN; Institutional Review Board, Virginia Commonwealth University, Richmond, VA
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Pascotto B, Poulain V, Ghistelinck B, Azagra JS. Covid no-related surgical emergencies during Covid-19 time. Case report: broad ligament internal hernia with associated small bowel necrosis. Cir Esp 2021; 99:547-549. [PMID: 34353592 PMCID: PMC7867399 DOI: 10.1016/j.cireng.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Beniamino Pascotto
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxembourg, Luxembourg.
| | - Virginie Poulain
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxembourg, Luxembourg
| | - Barbara Ghistelinck
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxembourg, Luxembourg
| | - Juan Santiago Azagra
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxembourg, Luxembourg
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Hashimoto Y, Kanda T, Chida T, Suda K. Recurrence hernia in the broad ligament of the uterus: a case report. Surg Case Rep 2020; 6:288. [PMID: 33196861 PMCID: PMC7669980 DOI: 10.1186/s40792-020-01030-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 09/23/2020] [Indexed: 01/29/2023] Open
Abstract
Background Bowel herniation through a defect in the broad ligament of the uterus is a rare disease and few cases of recurrence have been reported. We report herein a recurrence case of a patient with broad ligament hernia (BLH), along with a review of the literature. Case presentation A 53-year-old woman complaining of abdominal pain was transported to our hospital. She had a history of laparotomy for small-bowel obstruction associated with hernia in the broad ligament of the uterus 10 years ago at a local hospital. Abdominal pelvic contrast-enhanced computed tomography revealed that the mesentery of the dilated bowels converged at a thick band in the pelvis, suggesting closed loop obstruction of the small bowel. The patient underwent urgent laparotomy and was diagnosed with bowel herniation through an opening in the broad ligament of the uterus on the right side, which was ipsilateral with the previous surgery. The hernia orifice was widened by incision and incarcerated bowel segments were released and preserved because ischemia was reversible. The membranous defect of BLH was closed by suture with braded silk strings. Conclusions Although BLH is a rare disease, patients face a significant risk of disease recurrence. Nonabsorbable suture may be advisable for closure of the hernia orifice in BLH.
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Affiliation(s)
- Yoshifumi Hashimoto
- Department of Surgery, Sanjo General Hospital, TsukanomeNiigata, Sanjo, 955-0055, Japan.
| | - Tatsuo Kanda
- Department of Surgery, Sanjo General Hospital, TsukanomeNiigata, Sanjo, 955-0055, Japan
| | - Tadasu Chida
- Department of Surgery, Sanjo General Hospital, TsukanomeNiigata, Sanjo, 955-0055, Japan
| | - Kazuyoshi Suda
- Department of Surgery, Saiseikai Sanjo Hospital, Sanjo, Japan
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Koizumi N, Ariyoshi Y, Fujiki H, Sakakura C. Needlescopic surgery for broad ligament hernia: A case report. Asian J Endosc Surg 2020; 13:124-126. [PMID: 30767408 DOI: 10.1111/ases.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2018] [Accepted: 01/08/2019] [Indexed: 01/11/2023]
Abstract
Broad ligament hernia is a rare type of internal hernia. We herein report a case of broad ligament hernia successfully treated by needlescopic surgery. A 41-year-old woman was referred to our hospital with a complaint of nausea and vomiting. Abdominal contrast-enhanced computed tomography showed diffuse dilatation of the small bowel accompanied by a caliber change at the right side of the uterus. She was thus diagnosed with small bowel obstruction due to incarceration through right broad ligament hernia. After bowel decompression, she underwent elective needlescopic surgery using 2- and 3-mm instruments. The defect in the right broad ligament was closed with sutures, and she was discharged 2 days after surgery. In the treatment of broad ligament hernia without bowel ischemia, neither an abdominal incision nor any energy devices are required. In this respect, needlescopic surgery seems to be a promising approach among minimally invasive surgeries.
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Affiliation(s)
| | | | - Hiroshi Fujiki
- Department of Surgery, Akashi City Hospital, Akashi, Japan
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Broad Band Ligament Hernia Revisited (85 Cases of Allen-Master’s Syndrome; History and Perspectives). CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2019. [DOI: 10.1007/s13669-019-0260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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