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Case Reports
. 2024 Jun 4;16(6):e61664.
doi: 10.7759/cureus.61664. eCollection 2024 Jun.

Quain Hernia Masquerading as Mesenteric Ischemia

Karthik N  1 , Mahendra Lodha  1 , Niladri Banerjee  1 , Piyush Sharma  1 , Priya Chhawal  1
Affiliations
Case Reports

Quain Hernia Masquerading as Mesenteric Ischemia

Karthik N et al. Cureus. .

Abstract

The case describes a rare instance of Quain hernia, a specific type of internal hernia where the bowel protrudes through a defect in the broad ligament. Broad ligament defects can either be congenital or acquired. Quain hernias are uncommon and difficult to diagnose due to nonspecific symptoms. We report a case of a Quain hernia initially diagnosed as mesenteric ischemia with small bowel gangrene. If a Quain hernia is suspected, immediate diagnostic laparoscopy is recommended, as it is an effective diagnostic tool and definitive management method, regardless of the specific type. During the laparoscopic procedure, it is crucial to thoroughly assess the contralateral broad ligament to identify any defects, which should be repaired prophylactically if found. Understanding their rare presentation and distinctive radiological features is vital for prompt diagnosis and appropriate management, highlighting the need to consider uncommon etiologies in acute abdominal cases to optimize patient outcomes.

Keywords: bowel gangrene; broad ligament defects; laparotomy; mesenteric ischemia; quain hernia.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography showing ischemic small bowel loops.
In the axial plane computed tomography, there was evident diffuse circumferential thickening of distal ileal loops and suboptimal mucosal enhancement (blue arrow), all localized in the pelvic region. Red arrow showing anterior and right lateral displacement of the uterus.
Figure 2
Figure 2. Computed tomography showing non-enhancing ileal loops.
Coronal plane computed tomography demonstrating gangrenous changes of ileal loops within the pelvis (*) and mild dilatation of proximal small bowel loops. Additionally, a notable amount of moderate fluid was observed within the peritoneal cavity.
Figure 3
Figure 3. (A) Broad ligament defect. (B) Gangrenous ileal loops.
A: A defect measuring 5 x 4 cm in the left broad ligament caudal to the round ligament (* denotes the uterus). B: Gangrenous distal ileal loops of length 100 cm herniating through the defect in the left broad ligament. The distal-most extent of the gangrene was the ileocecal junction.
Figure 4
Figure 4. Anatomy of broad ligament.
Superior view of the female pelvis. (a) Uterus; (b) round ligament; (c) fallopian tube; (d) ovary; (e) ligament of the ovary; (f) urinary bladder; (g) rectum; (h) broad ligament; (i) ureteric fold; (j) broad ligament defect caudal to the round ligament. Image credits: Karthik N.
See this image and copyright information in PMC

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