Internal Hernia Through a Defect in the Left Broad Ligament of the Uterus: A case report

Kazunori Iwasa, Mitsugu Saitoh, Hideo Kitamura and Koichi Miwa*

Department of Surgery, Fukui General Hospital
* Department of Surgery II, Kanazawa University

We report a rare case of internal hernia through a defect in the left broad ligament of the uterus. A-44-year-old woman, without any previous surgical operation, was admitted to our hospital because of vomiting and lower abdominal pain from early in the morning. On the plain roentogenogram of the abdomen, a small amount of small intestinal gas was pointed out. US and CT studies showed dilated small bowel loops at the left side of the uterus. The patient was diagnosed with ileus of unknown origin and treated conservatively. However, her pain continued and the small bowel gas on a subsequent roentogenogram had increased. Therefore, an emergency operation was conducted on the third hospital day. Intra-operatively, we found an abnormal defect in the left broad ligament, 5.0cm in diameter, and the ileum approximately 80 cm proximal to the ileocecal valve, was herniated through this defect. After the herniated ileum was reduced, the defect was sutured and necrotized ileum was resected. With internal hernias, especially the rarest types, it is impossible to make a clear diagnosis before laparatomy. Only 50 such cases have been previously reported in Japanese literature. It is suggested that for female ileus patients without a history of surgery, we should consider this abnormal condition as a possible diagnosis, and CT may play an important role for correct diagnosis.

Key words
abnormal defect of the broad ligament, internal hernia, intestinal obstruction

Reprint requests
Kazunori Iwasa Department of Surgery, Fukui General Hospital< 1-2-1 Nittazuka, Fukui, 910-8561 JAPAN

Accepted
April 26, 2000

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