• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Laparoscopic management of small bowel obstruction secondary to herniation through uterine broad ligament

Laparoscopic management of small bowel obstruction secondary to herniation through uterine broad ligament

Dawit Worku, MD, MSc, MRCSEd, Abdulzahra Hussain, FRCSI, FRCSEng. Airedale Hospital NHS Foundation Trust

A healthy 37 year old multiparous woman presented to an emergency department with one day history of nausea, repeated vomiting, abdominal distension and obstipation. She had no previous history of abdominal surgery. On examination, she was reporting significant pain but was maintaining normal vital signs. Her abdomen was distended, with mild tenderness in the lower quadrants and hyperactive bowel sounds. The results of basic laboratory investigations (i.e., complete blood count, electrolyte panel and inflammatory markers) were normal. Computed tomography showed dilated loops of distal small bowel with transition area in the right pelvis, consistent with complete obstruction of the small bowel.

Initially, she was managed conservatively with intravenous fluids, nasogastric tube and nothing by mouth for the first 24 hours. When the conservative treatment failed, diagnostic laparoscopy was carried out. The findings were internal herniation of small bowel loops through a 6cm defect in the uterine broad ligament, between the round ligament and right adenexa. After reduction of the herniated bowel, the broad ligament defect was closed with intracorporeal suturing to prevent recurrence. The patient made an uneventful recovery post operatively and was discharged home few days later.

Herniation through a defect in the uterine broad ligament remains an uncommon cause of intestinal obstruction, accounting for about 4%–7% of internal hernias. Thus, it poses a significant diagnostic challenge pre-operatively. However, the possibility of internal herniation through a defect in the broad ligament should be considered in women presenting with obstruction of the small bowel when more common causes (i.e., adhesions, neoplasms, groin hernias) have been excluded.

Defects of the broad ligament may be either acquired or congenital. Acquired causes include trauma resulting from pregnancy or delivery, pelvic inflammatory disease or surgery is an acquired cause. In nulliparous patients, such defects may result from spontaneous rupture of cystic structures within the broad ligament that are thought to be congenital remnants of the mesonephric or mullerian ducts. Herniation or obstruction of the small bowel is the most commonly reported complication.

The management of small bowel obstruction secondary to herniation through broad ligament is operative, once conservative options are exhausted. A Trendelenburg position intraoperatively can assist in gentle reduction of incarcerated contents. Non viable bowel should be resected. Prevention of recurrent small bowel obstruction can be achieved by either closure of the defect (i.e. using clips or suture) or by dividing the broad ligament completely.

As this case demonstrates, small bowel obstruction due to herniation through uterine broad ligaments can safely be managed laparoscopically.

102

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals