Strangulated Small Bowel Obstruction Caused by Broad Ligament Hernia: Report of a Case and Review of Literature

摘要

Mechanical ileus is a common condition that physicians encounter in the emergency room. Adhesions should be considered first in a patient with a history of surgery, and other causes of bowel obstruction, such as colorectal cancer can be in the differential diagnosis. However, an unusual cause of mechanical ileus can make diagnosis difficult. Internal hernia is a representative unusual condition that is difficult to diagnose preoperatively. Here, we present a case of broad ligament hernia with strangulated small bowel obstruction. A 41-year-old woman presented with abdominal pain and distension since 3 days. Plain abdominal X-ray showed a loop of dilated bowel without free air. Emergent computed tomography revealed diffuse dilatation in the proximal-to-mid-ileal loop, with an abrupt luminal narrowing at the mid-ileum, but there was no evidence of bowel ischemia. Despite conservative management, the symptoms worsened, and peritoneal signs were apparent. During the operation, the terminal ileum was found to be herniated into a defect of the broad ligament. Because gangrenous changes were present, the incarcerated bowel was resected; an end-to-end anastomosis was performed, and the defect of the broad ligament was closed. This was an unusual case of internal hernia that could not be preoperatively diagnosed. Although the preoperative diagnosis was difficult because of its rarity, a high degree of suspicion is necessary; this diagnosis should be included in the differential evaluation of a female patient with mechanical ileus.