Broad ligament hernia-associated bowel obstruction

Abstract

Background and objective: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty.

Methods: The patient was admitted to the hospital's emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient's admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient's hospital stay, pain and vomiting increased in intensity and frequency.

Results: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach.

Conclusion: The patient's evolution was excellent.

Figure 1.

Abdominal plain radiograph showing dilated small bowel loops in the left upper quadrant.

Figure 2.

The herniated small bowel loop can be observed through the broad ligament orifice.

Figure 3.

The hernial orifice and the lower portion of the uterus are seen.

Figure 4.

Simple stitches were placed to close the defect.

Figure 5.

Closed hernia defect.