Presentation
Abdominal pain. Rule out diverticulitis or appendicitis.
Patient Data
The uterus is tilted in the coronal plane with its right side up. In continuity with the right uterine fundal region there is a soft tissue-density loop that wraps around bowel in the right iliac fossa, also in continuity with the right gonadic vessel region. This loop is felt to represent the right fallopian tube, broad ligament and adnexal region. Through this loop, most of the right colon, the entire cecum and a part of the distal ileum pass, with two adjacent transition points within the loop. Mild dilatation of the cecum. No signs of bowel ischemia.
Prior cholecystectomy. Surgical clip in the left adnexal region of unknown significance.
Findings are suggestive of an internal hernia through the right broad ligament.
Case Discussion
Laparoscopy confirmed a broad ligament hernia with dilated cecum, without signs of ischemia. A part of the greater omentum was also herniated, with tethering of adhesions from the prior cholecystectomy. Primary reduction and broad ligament defect closure was impossible, so the right adnexal loop was severed to release the bowel.
Special thanks to the surgeon Dr Annick Bussières.
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