A Case of Colonic Obstruction Associated with Uterine Broad Ligament Hernia Diagnosed Preoperatively and Treated by Laparoscopic Surgery

Abstract

A 49-year-old multiparous woman presented to our emergency department with lower abdominal pain of sudden onset and constipation for three days prior to admission. A preliminary plain abdominal CT revealed fecal ileus without evidence of bowel ischemia, warranting conservative management. However, the symptoms persisted without improvement, and the patient was readmitted three days later. A contrast-enhanced abdominal CT at this admission revealed sigmoid colon stenosis, with mesenteric vessels crossing over the uterine artery, based on which we made the diagnosis of broad ligament hernia. Moreover, elective laparoscopic surgery confirmed herniation of the sigmoid colon through a 2×4 cm defect in the left broad ligament, resulting in a closed-loop obstruction. The incarcerated bowel was then carefully released without resection, and the defect was closed using non-absorbable sutures. The patient experienced an uneventful postoperative course and was discharged on postoperative day seven, with no signs of recurrence having been observed during the nine months of follow-up since. Notably, broad ligament hernia is a rare cause of internal hernia, and cases involving the sigmoid colon are even rarer. Despite its rarity, this condition should be considered in the differential diagnosis of sigmoid colon obstruction, particularly in middle-aged multiparous women presenting with abdominal pain and constipation. Thus, accurate diagnosis and timely surgical intervention are crucial to prevent bowel ischemia and improve patient outcomes.