A Case Report of Internal Hernia Through an Abnormal Defect in the Broad Ligament (Pouch Type)

Masanobu Kiriyama, Shuuji Zennami, Takehiro Kato

Department of Surgery, Kamiyahagi Hospital

Internal herniation is relatively rare. Internal herniation through the broad ligament is extremely rare, and only 13 cases have been reported in Japan. We report here a case with strangulating obstruction of the small intestine, and the cases reported in the literature. The patient was a 68-year-old woman, admitted because of periodic abdominal pain and vomiting. She was followed conservatively. Three days later, the patient again complained of severe abdominal pain, and physical examination disclosed defense in the whole abdomen. She developed shock, and emergency laparotomy was performed. Surigical exploration showed moderate ascites, pale red and serose. There was a mass the size of an infant's head covering the left broad ligament, 5 cm in diameter, with approximately 2 m of small intestine herniated through this hiatus from the posterior direction. Part of the herniated bowel, 70 cm, was strangulated due to torsion of the small intestine. We diagnosed this case as internal herniation through an abnormal defect in the broad ligament, pouch type. Resection of the herniated bowel by left adnexectomy was performed. The patient recovered and was discharged on the 27th postoperative day.

Key words
internal hernia, stragulating obstruction

Reprint requests
Masanobu Kiriyama Second Department of Surgery, Nagoya City University Medical School
1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467 JAPAN

Accepted
July 6, 1994

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