Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 450  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (316 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Case report
 ::  Discussion
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed8103    
    Printed238    
    Emailed5    
    PDF Downloaded154    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


 


 
CASE REPORT
Year : 2000  |  Volume : 46  |  Issue : 3  |  Page : 189-90

Jejunal obstruction and perforation resulting from herniation through broad ligament.


Surgery Division, Burhani Charitable Trust Hospital, Anand Koliwada, Mumbra, Dist. Thane-400 612, India. , India

Correspondence Address:
A S Kanbur
Surgery Division, Burhani Charitable Trust Hospital, Anand Koliwada, Mumbra, Dist. Thane-400 612, India.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 11298469

Rights and PermissionsRights and Permissions


 :: Abstract 

Internal herniation of small bowel through broad ligament causing obstruction is rare. A case of jejunal herniation through broad ligament defect with resultant obstruction and perforation is presented.


Keywords: Abdomen, Acute, diagnosis,Anastomosis, Surgical, Broad Ligament, abnormalities,Case Report, Colectomy, methods,Female, Follow-Up Studies, Hernia, complications,diagnosis,surgery,Human, Intestinal Obstruction, diagnosis,etiology,surgery,Intestinal Perforation, diagnosis,etiology,surgery,Jejunal Diseases, diagnosis,etiology,surgery,Middle Age,


How to cite this article:
Kanbur A S, Ahmed K, Bux B, Hande T. Jejunal obstruction and perforation resulting from herniation through broad ligament. J Postgrad Med 2000;46:189

How to cite this URL:
Kanbur A S, Ahmed K, Bux B, Hande T. Jejunal obstruction and perforation resulting from herniation through broad ligament. J Postgrad Med [serial online] 2000 [cited 2019 Nov 14];46:189. Available from: http://www.jpgmonline.com/text.asp?2000/46/3/189/280


Incidence of small bowel obstruction due to internal herniation is rare and accounts for about 1% of acute obstructions. Broad ligament defects can cause small bowel to herniate through them, which in turn lead to complications like obstruction, strangulation or perforation. This is a rare cause to be borne in mind in a female patent with intestinal obstruction.




  ::   Case report Top


A 48 year old female patient, with known history of mitral valve prolapse with regurgitation, but otherwise in good health, was admitted with severe lower abdominal pain, nausea and vomiting of acute onset. There was no history of fever, trauma, vaginal or abdominal operations. She was postmenopausal and had two normal deliveries.

On examination, her vital parameters were normal. Abdomen was marginally distended and there was slight tenderness at umbilicus. Digital rectal examination and per vaginal examinations were normal. Hyperperistalsis was present. She also had a murmur consistent with mitral valve regurgitation. On admission, all haematological and biochemical investigations were normal. Plain x-ray abdomen in standing position showed dilated loops of jejunum in left upper quadrant with no air fluid levels. Ultrasound of abdomen revealed no abnormality except dilated bowel loops without free fluid in abdomen.

Initially she received conservative line of treatment with naso-gastric decompression, intravenous fluids and antibiotics. Forty-eight hours later, she developed obstipation; her pain worsened and she had tachycardia. Rectal tenderness was present with ballooning suggestive of obstruction. Repeat plain x-ray abdomen standing showed further distension of gas filled loops with air fluid levels but no free air under diaphragm. Water soluble contrast follow through was obtained through the nasogastric tube, which showed dilated jejunum with complete obstruction but no perforation. Facility for computed tomography scan was not available in our setting. A clinical diagnosis of jejunal obstruction was made.

At exploration, the mid-jejunum had herniated through a narrow defect in the left broad ligament causing obstruction and perforation [Figure - 1]. There was little peritoneal contamination indicating recent perforation. Local resection of jejunum was performed. Defect was below the round ligament but above major uterine vessels [Figure - 2]. This was closed in vicryl sutures. Patient had an uneventful recovery.




  ::   Discussion Top


Small bowel obstruction due to internal herniation is rare. Common causes are adhesions, strangulated inguinal hernias and neoplasms. Even rare is the herniation through broad ligament defects. The earliest reported case of herniation of bowel through a defect in broad ligament of uterus was by Slezak,[1] found at autopsy.

Broad ligament defects are classified as being congenital or acquired. Congenital causes have an embryological basis due to developmental defect in supports of the uterus. Acquired ones are due to previous surgery, trauma during delivery, perforations following vaginal manipulations and pelvic inflammatory disease. A classification of broad ligament defects has been proposed based on the anatomical position of the defect.[2] Type I defect caudal to round ligament; type II defect above broad ligament; and type III between round ligament and remainder of broad ligament, through meso-ligamentum teres.

There have been few reports of bowel herniating through broad ligament.[3] Incidents such as obstruction and even strangulation have been reported but these are isolated events.[4],[5] Tanaka et al have described a case of broad ligament hernia following surgery for obturator hernia, indicating surgical interference as an acquired cause.[6]

Early diagnosis of such cases need high index of suspicion, particularly in female patients who present with small bowel obstruction and have no history of operations in the past. Though plain x-ray abdomen and ultrasound give a clue, the accuracy in pinpointing the cause lies with computed tomography scan, as is exemplified by Suzuki et al.[7]

 
 :: References Top

1. Slezak FA, Schlueter TM. Hernia of the broad ligament of the uterus. In: Nyhus LM, Codon RE, editors. Hernia. 3rd Edition. Philadelphia: J. B. Lippincott; 1989. pp 311-316.  Back to cited text no. 1    
2.Cilley R, Poterack K, Lemmer J, Dafoe D. Defects of the broad ligament of the uterus. Am J Gastroenterol 1986; 81:389-391.  Back to cited text no. 2    
3.Cleator IG, Bowden WM. Bowel herniation through a defect of the broad ligament. Br J Surg 1972; 59:151-153.  Back to cited text no. 3    
4.Simstein NL. Internal herniation through a defect in the broad ligament. Am Surg 1987; 53:258-259.  Back to cited text no. 4    
5.Ishihara H, Terahara M, Kigawa J, Terakawa N. Strangulated herniation through a defect of the broad ligament of the uterus. Gynecol Obstet Invest 1993; 35:187-189.  Back to cited text no. 5    
6.Tanaka M, Kaneko Y, Ietsugu K, Yoshida C. Internal herniation through a broad ligament defect after obturator hernia repair. Surg Today 1994; 24:634-637.  Back to cited text no. 6    
7.Suzuki M, Takashima T, Funaki H, Uogishi M, Isobe T, Kanno S, et al. Radiologic imaging of herniation of the small bowel through a defect in the broad ligament. Gastrointest Radiol 1986; 11:102-104.   Back to cited text no. 7    


    Figures

[Figure - 1], [Figure - 2]

This article has been cited by
1 Strangulation of the bowel through a defect of the broad ligament of the uterus: A rare case in geriatry
Haguenauer, D., Safar, H., Roger, M.
Revue de Geriatrie. 2004; 29(10): 821-824
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow