A case of herniation through a peritoneal defect in the douglas cavity

Abstract

It has been reported that internal hernias represent about 1% of all causes of ileus. In this paper we present a case of herniation through a peritoneal defect in the Douglas cavity, which is so rare that only other three cases have been reported so far.
A 40-year-old woman was seen at the hospital because of nausea, vomiting, and periomphalic pain. The abdomen was flat and soft. Abdominal plain x-ray examination and contrast-enhanced CT scan showed findings of small intestinal obstruction. By placing a long tube, conservative therapy was started with a diagnosis of intestinal obstruction of unknown origin, but no symptomatic remission was gained. On the 10^th day after the onset of the symptoms, laparoscopic procedure for reducing ileus was performed, when we saw that the ileum was impacted in a peritoneal defect in the Douglas cavity. The herniated ileum was reduced, the peritoneal defect was closed by applying a clip, and then the operation was completed.