Abstract
Herniation through an abnormal hiatus in the broad ligament of the uterus, in which there is an abnormal hiatus in the broad ligament of the uterus and the intestinal tract is incarcerated, accounts for from 1.27% to 3.8% of all internal hernias.
Case 1 : A 51-year-old female who underwent an appendectomy at the age of 14. She was treated with I.V. fluids at a nearby clinic after complaining of upper abdominal pain and nausea. On the third day, she was referred to our hospital for further examination. Although her abdominal area was swollen and tenderness was observed throughout the abdominal part, there was no rebound tenderness or muscular guarding. An expansion of the small intestine was observed using a CT and US but there were no ascites. Blood tests revealed a severe inflammatory reaction and dehydration. Upon insertion of an ileus tube, ileus tube imaging was performed on the fourth day. Because a complete obstruction of the small intestine was found in the right pelvis, the patient was determined to be a candidate for surgery and a laparotomy was thus performed. A hiatus measuring approximately 1.5cm in size was observed in the right broad ligament of the uterus where the ileum was invaginated by approximately 20cm and it had also necrotized. The small intestine was resected and the site of the hiatus was directly obstructed. On the 15th day after the operation, the patient was released from the hospital.
Case 2 : A 53-year-old female with no history of a laparotomy. She felt discomfort in her abdominal area and had not felt well since the same morning. Because the symptoms did not improve, she visited our hospital in the evening. Although swelling was found throughout the entire abdomen, there was no spontaneous pain, tenderness, or nausea. A CT scan revealed an expansion of the small intestine and mild ascites. Progress was monitored conservatively but the patient repeatedly vomited. An additional CT was thus performed on the second day, which revealed an exacerbation of the swelling in the small intestine and increased ascites, thus resulting in emergency surgery. A hiatus of approximately 2cm was observed in the left broad ligament of the uterus where the ileum was invaginated by approximately 5cm. Manual repositioning was performed and the small intestine was not resected. On the ninth day after the operation, the patient was released from our hospital.
