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. 2019:65:354-357.
doi: 10.1016/j.ijscr.2019.11.024. Epub 2019 Nov 19.

Herniation of the broad ligament… And the other side?

J Zemour  1 , X Coueffe  2 , H Fagot  2
Affiliations

Herniation of the broad ligament… And the other side?

J Zemour et al. Int J Surg Case Rep. 2019.

Abstract

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.

Keywords: Broad ligament; Case report; Internal hernia; Small bowel obstruction.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
CT image reveals a closed dialed loop localized to the right of the uterus (arrow).
Fig. 2
Fig. 2
Intraoperative photograph. The herniated ileum loop can be observed through the broad ligament orifice. U: Uterus, F: Fallopian Tube, R: Round Ligament, I: Ileum.
Fig. 3
Fig. 3
Illustration of the broad ligament; showing classification of broad ligament defects.
See this image and copyright information in PMC

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