Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 3 , Pages 273-275, September 2005

Internal Herniation Through a Defect in the Broad Ligament of the Uterus

  • Daw-Yuan Chang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • ,
  • Mei-Jou Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • ,
  • Shee-Uan Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • ,
  • Horng-Nerng Ho

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • Department of Medical Research, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    • ,
  • Yu-Shih Yang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr. Yu-Shih Yang, Department of Obstetrics and Gynecology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan

Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan

Received 18 December 2004; received in revised form 22 December 2004; accepted 22 December 2004.

Article Outline

Summary 

Objective

Intestinal obstruction caused by internal herniation of the bowel at a tear in the uterine broad ligament is extremely rare. Accurate preoperative diagnosis is very difficult. Here, we present a case with internal herniation through a defect in the broad ligament of the uterus.

Case Report

A 41-year-old female complained of colicky pain over the lower abdomen, nausea, and vomiting for 2 days. No significant history except cesarean section was given. Transvaginal ultrasound revealed a cystic structure with peristalsis located at the broad ligament of the uterus. Highly suspicious of bowel obstruction, we performed an emergency laparoscopy and discovered intestinal herniation at a broad ligament tear. The herniated bowel loop was reduced and the tear was sutured primarily. The reduced bowel loop was viable with no evidence of gangrene or perforation. The patient recovered uneventfully.

Conclusion

Good prognosis relies on early surgical correction before bowel gangrene or perforation of the strangulated bowel, especially in patients with previous gynecologic or obstetric surgery. Transvaginal ultrasound by an experienced operator may be helpful for this diagnosis.

Key Words:  bowel obstruction , broad ligament of the uterus , internal hernia , laparoscopy

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Baron A . Defect in the broad ligament and its association with intestinal strangulation . Br J Surg . 1948;36:91–94
  2. Suzuki M , Takashima T , Funaki H , et al.   Radiologic imaging of herniation of the small bowel through a defect in the broad ligament . Gastrointest Radiol . 1986;11:102–104
  3. Tanaka M , Kaneko Y , Ietsugu K , Yoshida C . Internal herniation through a broad ligament defect after obturator hernia repair . Surg Today . 1994;24:634–637
  4. Kanbur AS , Ahmed K , Bux B , Hande T . Jejunal obstruction and perforation resulting from herniation through broad ligament . J Postgrad Med . 2000;46:189–190
  5. Livaudais W , Hartong JM , Otterson WN . Small bowel herniation through a defect in the broad ligament . Am J Obstet Gynecol . 1979;133:927–928
  6. Simstein NL . Internal herniation through a defect in the broad ligament . Am Surg . 1987;53:258–259
  7. Bertelsen S , Christiansen J . Internal hernia through mesenteric and mesocolic defects. A review of the literature and a report of two cases . Acta Chir Scand . 1967;133:426–428
  8. Cleator IG , Bowden WM . Bowel herniation through a defect of the broad ligament . Br J Surg . 1972;59:151–153
  9. Armstrong CP , Drummond A . Small bowel obstruction and perforation through a defect in the broad ligament . J R Coll Surg Edinb . 1983;28:333–334
  10. Ishihara H , Terahara M , Kigawa J , Terakawa N . Strangulated herniation through a defect of the broad ligament of the uterus . Gynecol Obstet Invest . 1993;35:187–189

PII: S1028-4559(09)60153-4

doi:10.1016/S1028-4559(09)60153-4

Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 3 , Pages 273-275, September 2005

Article Tools