Katsuhiro Tomofuji, MD, Shinsuke Kajiwara, MD, Kenzo Okada, MD, Kenji Nedu, MD, Jyota Watanabe, MD, Yoshinori Imai, MD, Naoki Ishida, MD, Yusuke Nakagawa, MD, Tomoyuki Nagaoka, MD, Yusuke Nishi, MD. Uwajima city hospital
Broad ligament hernia of the uterus is a rare hernia that may cause small bowel obstruction through a defect or pouch in a broad ligament of the uterus. Here we report two cases of broad ligament hernia that were successfully treated by a laparoscopic single-site approach.
A 45-year-old female was admitted due to abdominal pain and vomiting. Abdominal computed tomography (CT) showed a small bowel obstruction near the broad ligament on the left side. Intestinal obstruction due to an internal hernia through the left broad ligament of the uterus was suspected, so we performed an emergency operation. A single incision was made at the umbilicus, and a defect of the left broad ligament was identified. A viable ileal loop was incarcerated through the defect. The constricted bowel was easily released, and the orifice was sutured.
The second case was a 44-year-old female who had abdominal pain, and in whom CT revealed findings identical to those of the first case. We performed an emergency operation. There was no bowel necrosis, and the orifice was sutured without resecting the incarcerated intestine.
We report here two patients in whom we pre-operatively diagnosed small bowel obstruction due to broad ligament hernia, and who underwent single-site surgery. Both cases had good postoperative courses.
Broad ligament hernia is rare, and comprises 1.5–5% of internal hernias. The rate of pre-operative diagnosis is low (10.4%), but this has been improved recently by technological developments in CT. The operative procedure involves releasing incarcerated bowel, and closing or opening an orifice. A laparoscopic single-site approach uses one trans-abdominal incision rather than multiple sites for trocar placement. The procedure is designed to decrease abdominal wall trauma and improve cosmesis. The two cases reported herein suggest that broad ligament hernia of the uterus should be considered in cases of small bowel obstruction in female patients, and that single-site laparoscopic surgery is effective if bowel drainage has been performed.