Two cases of intestinal obstruction due to strangulation of a loop of small intestine in an opening of the left broad ligament

Abstract

STRANGULATION of small intestine in an opening in the broad ligament seems to be very rare. A few cases of strangulation in pouches have been reported by C. H. Faggel and B. H. Pidcock,2 and one that I have been able to discover, through an opening in the ligament in the absence of a pouch, by H. A.The number is so small that the addition of the following two case reports should be of value.Case ].-The first case was that of a married woman, age 58 years, who during the previous ten months had had repeated attacks of abdominal pain, These attacks had lasted from a few minutes to several hours, and had consisted of recurring severe cramps in the region of the navel. They occurred more frequently at night than in the daytime and were eased by walking about.The last attack had begun twenty-four hours before admission to hospital, and had been much more severe than any experienced before; it had been accompanied by abdominal distension and repeated vomiting. There was symmetrical distension of the whole abdomen, which was slightly tender all over. A moderately tender, somewhat cystic mass was felt behind the uterus.On entering the abdomen a coil of small intestine, 15 in. long, was found to have passed through a small opening in the left broad ligament. The bowel was distended, slightly acdematous, and tense. It entered the opening from in front and lay for the most part in the pouch of Douglas. The opening was a little less than 2 cm. in diameter and lay below the round ligament and Fallopian tube, immediately lateral to the uterine vessels. It was easily enlarged by the fingers, and the strangulated coil was then withdrawn. No sac was present. The margins of the opening were approximated with catgut and the abdomen was closed.Case 2.-The second patient was a woman, age 36 years, the mother of seven children. Two or three months previously she had had an attack of abdominal pain which lasted one hour. Three days before operation she had developed severe crampy abdominal pain. In the first twelve hours this had remained severe in character and she had vomited two or three times. Since then there had been little or no pain, although the abdomen continued to feel sore. For a few hours before operation there had been some bloating and frequent vomiting. There was moderate general distension of the abdomen, which was tender in the left lower quadrant. The uterus was retroverted and freely movable, although movement caused some pain. There was tenderness in the left lateral fornix.On only one occasion had vomiting occurred.Recovery was uneventful.