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

Abstract

Introduction Broad ligament hernia (BLH) is a rare but potentially life threatening condition. One of the two cases described here is the only reported case of BLH in recent literature, where marsupialisation was done. These two case reports comprise the only reported side by side pictorial comparison of the two laparoscopic surgical therapeutic options for BLH. Presentation of cases Both patients presented with classical symptoms and signs of acute intestinal obstruction. Imaging confirmed obstructed left BLH in case 2 and indicated a complete small bowel obstruction in case 1. Both cases were successfully managed laparoscopically. Both patients had an uneventful immediate postoperative recovery and have not had recurrence over a mean follow up period of 34.5 months. Discussion BLH is rare among all types of internal herniae. It accounts for only 4% of internal herniae and is a difficult condition to diagnose. The advent of computed tomography has increased chances of accurate preoperative diagnosis. Conclusion BLH can be successfully managed by minimally invasive surgery, even in the acute setting. When tightly entrapped bowel is unyielding; it is better not to risk injury to it by aggressive attempts at its reduction. It is safer to attempt widening of the defect into which it is entrapped, whenever feasible.

Internal hernia secondary to unexpected broad ligament defect: A case report

“…3 The spectrum of symptoms ranging from none to an acute incarcerated hernia makes the diagnosis challenging and results in late treatment. 4 The optimal surgical approach is controversial between open and laparoscopic techniques. 5…”

“…The aetiology can be congenital or acquired (secondary to operative trauma, endometriosis, or pelvic inflammatory disease) 3 . The spectrum of symptoms ranging from none to an acute incarcerated hernia makes the diagnosis challenging and results in late treatment 4 . The optimal surgical approach is controversial between open and laparoscopic techniques 5 …”

Broad ligament hernia: A rare condition causing small bowel obstruction

“…Mechanical SBO with double transitional zone, bowel loops herniated beside the uterus with slight deviation of uterus to the contralateral side, enlargement of the distance between the uterus and one of the ovaries, and presence of free fluid in the pelvis would lead to suspicion of broad ligament herniation. [1] A standard therapeutic intervention has not yet been established. [2] Diagnostic laparoscopy could be performed if the preoperative diagnosis is uncertain.…”