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Internal hernia through a defect in the broad ligament
Journal of Visceral Surgery (2012) 149, e161—e162
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SURGICAL IMAGES
Internal hernia through a defect in the broad ligament U.-D. Ngabou ∗, E. Hornez , P. Chiron , M. Fondin , F. Pons Service de chirurgie viscérale et thoracique, hôpital d’instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart cedex, France
Case report A 42-year-old woman, uniparous and without any surgical history, was hospitalized for acute intestinal obstruction. CT scan showed jejunal loop distension; the boundary between dilated and non-dilated small intestines was located just to the left of the uterus (Fig. 1). Laparoscopic exploration found an internal hernia: a portion of the small intestines was incarcerated in a left broad ligament defect (Fig. 2). After reduction of the herniated small intestine, the defect was closed to prevent recurrence. The postoperative course was uneventful and the patient was discharged home on day 3. Internal hernia through the broad ligament is rare, representing 4—7% of all internal hernias [1,2]. They can be acquired or congenital. Three types of hernia have been described according to the location of the defect [3]. The defect can be complete, as in our report: in this case, there is no sac. Its rarity is a cause of delay in diagnosis. Abdominopelvic CT scan can be suggestive when the boundary between dilated and non-dilated intestines is found lateral to the uterus. However, other causes, such as de novo bands or postoperative obstruction can be discussed, according to patient history. Laparoscopy can be useful in establishing the diagnosis, as shown in our patient. Prevention of recurrence, performed during the same operation, should be the rule.
∗
Corresponding author. E-mail address: [email protected] (U.-D. Ngabou).
1878-7886/$ — see front matter © 2012 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.jviscsurg.2012.03.004
e162
Figure 1.
U.-D. Ngabou et al.
Scanner: dilated and non-dilated small intestine junction located left side from the uterus. U: uterus.
Figure 2. A: small intestine internal hernia (i) through a left broad ligament defect; O: ovary; U: uterus; T: tube; B: of the herniated small intestine; RL: round ligament; C: visualization of the wound defect between the tube and the round ligament; D: reduction of the herniated small intestine, the defect was closed to prevent recurrence.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
References [1] Kotobi H, Echaieb A, Gallot D. Traitement chirurgical des hernies rares. EMC, Techniques Chirurgicales - Appareil Digestif 2005:440—5.
[2] Masato F, Shiro T, Naoki H. Strangulated herniation through a defect in the broad ligament. Surgery 2002;131:232—3. [3] Chapman VM, Rhea JT, Novelline RA. Internal hernia through a defect in the broad ligament: a rare cause of intestinal obstruction. Emerg Radiol 2003;10:94—5.
Available online at
www.sciencedirect.com
SURGICAL IMAGES
Internal hernia through a defect in the broad ligament U.-D. Ngabou ∗, E. Hornez , P. Chiron , M. Fondin , F. Pons Service de chirurgie viscérale et thoracique, hôpital d’instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart cedex, France
Case report A 42-year-old woman, uniparous and without any surgical history, was hospitalized for acute intestinal obstruction. CT scan showed jejunal loop distension; the boundary between dilated and non-dilated small intestines was located just to the left of the uterus (Fig. 1). Laparoscopic exploration found an internal hernia: a portion of the small intestines was incarcerated in a left broad ligament defect (Fig. 2). After reduction of the herniated small intestine, the defect was closed to prevent recurrence. The postoperative course was uneventful and the patient was discharged home on day 3. Internal hernia through the broad ligament is rare, representing 4—7% of all internal hernias [1,2]. They can be acquired or congenital. Three types of hernia have been described according to the location of the defect [3]. The defect can be complete, as in our report: in this case, there is no sac. Its rarity is a cause of delay in diagnosis. Abdominopelvic CT scan can be suggestive when the boundary between dilated and non-dilated intestines is found lateral to the uterus. However, other causes, such as de novo bands or postoperative obstruction can be discussed, according to patient history. Laparoscopy can be useful in establishing the diagnosis, as shown in our patient. Prevention of recurrence, performed during the same operation, should be the rule.
∗
Corresponding author. E-mail address: [email protected] (U.-D. Ngabou).
1878-7886/$ — see front matter © 2012 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.jviscsurg.2012.03.004
e162
Figure 1.
U.-D. Ngabou et al.
Scanner: dilated and non-dilated small intestine junction located left side from the uterus. U: uterus.
Figure 2. A: small intestine internal hernia (i) through a left broad ligament defect; O: ovary; U: uterus; T: tube; B: of the herniated small intestine; RL: round ligament; C: visualization of the wound defect between the tube and the round ligament; D: reduction of the herniated small intestine, the defect was closed to prevent recurrence.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
References [1] Kotobi H, Echaieb A, Gallot D. Traitement chirurgical des hernies rares. EMC, Techniques Chirurgicales - Appareil Digestif 2005:440—5.
[2] Masato F, Shiro T, Naoki H. Strangulated herniation through a defect in the broad ligament. Surgery 2002;131:232—3. [3] Chapman VM, Rhea JT, Novelline RA. Internal hernia through a defect in the broad ligament: a rare cause of intestinal obstruction. Emerg Radiol 2003;10:94—5.