Small bowel obstruction due to broad ligament hernia: computed tomography findings

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

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Broad ligament hernia as a rare cause of acute small bowel obstruction: A wolf in sheep’s clothing – A case report with review of the literature

Indian Journal of Case Reports ◽

10.32677/ijcr.2020.v06.i12.006 ◽

2020 ◽

Vol 6 (12) ◽

pp. 691-693

Author(s):

Rafique Umer Harvitkar ◽

Bhavesh Shelke ◽

Abhijit Joshi

Keyword(s):

Case Report ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Broad Ligament ◽

Review Of The Literature ◽

Acute Small Bowel Obstruction

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Small bowel obstruction secondary to internal hernia through a defect of the broad ligament: preoperative multi-detector CT diagnosis

Abdominal Imaging ◽

10.1007/s00261-012-9846-x ◽

2012 ◽

Vol 37 (6) ◽

pp. 1089-1091 ◽

Cited By ~ 9

Author(s):

Sergi Quiroga ◽

Manuel Sarrias ◽

José Luis Sánchez ◽

Joaquín Rivero

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Internal Hernia ◽

Broad Ligament ◽

Ct Diagnosis

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Small Bowel Obstruction by Broad Ligament Hernia: Three Case Reports, Management and Outcomes

Acta Médica Portuguesa ◽

10.20344/amp.10951 ◽

2019 ◽

Vol 32 (3) ◽

pp. 240

Author(s):

Manuela Graça Fernandes ◽

Ana Rita Mateus Loureiro ◽

Maria João Diogo Obrist ◽

César Prudente

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Case Reports ◽

Broad Ligament ◽

Exploratory Laparotomy ◽

Anatomical Location ◽

Internal Hernias ◽

Surgical History ◽

Broad Ligament Defect

Internal hernias are a rare cause of bowel obstruction (1%) and can be caused by broad ligament defects in 4% to 7% of the cases. These defects may be congenital or acquired and are classified according to its anatomical location. This paper reports three cases of small bowel obstruction by broad ligament hernia. The patients, three women aged from 35 to 51 years old, were admitted to the emergency department with small bowel obstruction. An exploratory laparotomy was performed during which an internal hernia through a broad ligament defect was identified. In all cases the hernia content was reduced and the defect closed. One of the patients required a segmental enterectomy. All patients had a favorable outcome. This paper aims to raise awareness about the broad ligament hernia as a cause of bowel obstruction, namely in middle-aged women with no surgical history.

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