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

Abstract

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.

Case report: Emergency management of unilateral herniation of bowel and a bilateral defect of the broad ligament in a resource limited setting

“…Only 4 % of internal hernias are reported as broad ligament hernias [ 2 , 4 ]. The rarity of BLH occurrence itself presents a diagnostic challenge and leads to skepticism regarding a standardized treatment strategy.…”

Broad ligament hernia: Two contrasting ways to a common goal – Two case reports with review of literature

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Fig. 7 Review of recent literature on BLH [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] .

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Herniation Through Defects in the Broad Ligament

“…Congenital causes are secondary to the spontaneous rupture of congenital cystic structures, which are related to developmental abnormalities in the pelvic peritoneum. 11,12 Acquired defects are secondary to operative trauma, pregnancy, birth trauma, inflammatory pelvic disease, or disease processes like endometriosis causing significant damage to the mesentery. 11,13 Allen-Masters syndrome, originally introduced in 1955, describes a clinical syndrome which may result from defects in the broad ligament as well as the cul-de-sac or uterosacral ligament.…”