Sathiyanathan Kirushanth, Tharmakulasingham Nissanthan, Dias Senuri, Navarathnam Chrishan, Perera Eranga
Department of Surgery, Postgraduate Institute of Medicine, University of Colombo, Colombo, LKA.
Emergency Department, District General Hospital Avissawella, Avissawella, LKA.
Cureus. 2025 Jul 12;17(7):e87766. doi: 10.7759/cureus.87766. eCollection 2025 Jul.
Internal hernias represent an uncommon etiology of small bowel obstruction (SBO). Among these, herniation through a defect in the broad ligament is one of the least common types. Because symptoms are vague and imaging findings are often minimal, these presentations can be easily overlooked and may progress to bowel ischemia or gangrene. A 47-year-old multiparous woman with no history of abdominal surgery presented to the emergency department with severe, worsening abdominal pain that developed over the past 12 hours. Ultrasound was the only imaging modality available. It detected free fluid in the abdomen but did not identify a specific organ abnormality. The clinical team initially proceeded with an open appendicectomy, which was subsequently converted to an exploratory laparotomy. During the procedure, they identified an internal hernia that had passed through a defect in the left broad ligament. Approximately 25 cm of the necrotic bowel was resected, and the remaining segments were joined with a primary anastomosis. Postoperatively, the patient recovered without incident and was discharged home once her bowel function resumed. While broad ligament hernias are exceedingly rare, they should be kept in mind as a possible explanation for obstruction in females who have not undergone pelvic surgery. Preoperative diagnosis is frequently missed because of subtle imaging clues and the infrequency of the disease in everyday practice. When advanced radiology is limited or inconclusive, surgical exploration remains the most reliable route to both identify the problem and provide timely treatment. Although rare, broad ligament hernias should be considered in female patients presenting with SBO and no prior abdominal operations. Prompt recognition and surgical intervention are vital to minimize morbidity and mortality.
腹内疝是小肠梗阻（SBO）的一种罕见病因。其中，通过阔韧带缺损处的疝是最不常见的类型之一。由于症状模糊且影像学表现通常不明显，这些表现很容易被忽视，并可能进展为肠缺血或坏疽。一名47岁、有多次分娩史且无腹部手术史的女性因在过去12小时内出现的严重且逐渐加重的腹痛前往急诊科就诊。超声是唯一可用的影像学检查方式。它检测到腹腔内有游离液体，但未发现特定器官异常。临床团队最初进行了开放式阑尾切除术，随后改为剖腹探查术。在手术过程中，他们发现了一个通过左侧阔韧带缺损处的腹内疝。切除了约25厘米坏死的肠段，其余肠段进行了一期吻合。术后，患者顺利康复，肠道功能恢复后出院回家。虽然阔韧带疝极为罕见，但对于未接受盆腔手术的女性，应将其视为肠梗阻的一种可能原因。由于影像学线索不明显且该病在日常实践中罕见，术前诊断常常被漏诊。当先进的影像学检查受限或结果不明确时，手术探查仍然是识别问题并提供及时治疗的最可靠途径。尽管罕见，但对于出现SBO且无既往腹部手术史的女性患者，应考虑阔韧带疝。及时识别和手术干预对于降低发病率和死亡率至关重要。
