Rare Contents of an Internal Hernia through a Defect of the
Internal hernias are rare causes of bowel obstruction, and internal herniation through a defect of the broad ligament of the uterus is even rarer, accounting for 4%-5% of all internal hernias. Hernia contents usually include the ileum. In addition, several studies have reported constriction of organs such as the colon and fallopian tube in patients with internal hernia. A 52-year-old woman presented to the hospital with lower abdominal pain and vomiting that started 6 hours prior to presentation. Her past medical history was significant for bowel obstruction following cesarean section. She denied having any fever or chills. There was no rebound tenderness or abdominal guarding. Laboratory test results showed an elevated white blood cell count (11,000/mm3). Contrast-enhanced abdominopelvic computed tomography (CT) showed a distended, fluid-filled closed loop with mesenteric fat haziness at the right side of the uterus, which was deviated to the left. The bowel wall enhancement was normal. However, there was a spheroidal area of poor enhancement adjacent to the distended small intestines, assuming it was the right ovary or ascites.

Following the diagnosis of a closed-loop obstruction associated with bowel herniation in the right broad ligament of the uterus, emergency surgery was performed. Laparoscopic exploration revealed a viable ileal loop and an organ suspected to be ischemic. Surgeons then switched to laparotomy to enable examining this incarcerated organ. Laparotomy showed that incarceration was caused by herniation through the right broad ligament of the uterus in a posterior-to-anterior direction. The length of strangulated ileal loop was approximately 30 cm, which was preserved and had no ischemic changes. The organ with suspected ischemia was the enlarged ampullary portion of the right fallopian tube, which was incarcerated and gangrenous. They reduced the hernia and performed a right salpingectomy. The hernial orifice diameter was 3.0 cm, and the defect was closed with a continuous suture. The patient had a favorable postoperative course and was discharged home on postoperative day 8.