2011 Volume 44 Issue 2 Pages 213-218
We report a rare case of internal hernia of the rectouterine pouch and suggest caliber ileal change in the pelvic space in computed tomography (CT) may indicate this disease. A 31-year-old woman admitted for abdominal pain, vomiting, and diarrhea was found in enhanced CT hospital day 2 to have a small-bowel obstruction and caliber ileal change on the dorsal side of the uterus in the pelvic space. Immediate ileus tube insertion to decompress the gastrointestinal tract temporarily relieved symptoms until hospital day 6, when abdominal pain was aggravated. CT showing free air and ascites in the peritoneal cavity necessitated emergency surgery based on a diagnosis of peritonitis due to intestinal perforation. The terminal ileum was found incarcerated in an abnormal peritoneal opening of the rectouterine pouch, along with two small ileal perforation sites 20cm from the incarceration. Releasing the incarcerated bowel revealed a peritoneal opening 1.5cm in diameter. In the absence bowel necrosis, we closed the peritoneal opening and drained ileal perforation sites. The abnormal peritoneal opening appeared to have developed congenitally.
