Small bowel obstruction due to broad ligament hernia successfully treated by laparoscopy

We present the second case of a broad ligament hernia to be treated by laparoscopy. A 43-year-old gravida 0, para 0 woman presented to our hospital with a chief complaint of right upper quadrant abdominal colicky pain and vomiting. Her clinical history was significant for an "unknown" bowel surgery through a Pfannenstiel incision. Her abdomen was soft, nondistended, and slightly tender to palpation in the right upper quadrant. The laboratory tests showed an elevated white blood cell count of 15.2 [ 1] 109/L with a left shift, and a normal serum C-reactive protein. Plain abdominal X-rays showed a lightly prominent small bowel loop in the pelvic area. An abdominal ultrasound revealed only a small amount of fluid in the pouch of Douglas. After 24 hours, the pain had migrated to the hypogastrium. There was an increase in the white blood cell count, in the C-reactive protein level, and in her temperature (37.7 degrees C). At this stage, we elected to perform an urgent laparoscopic exploration. We discovered 60-80 cm of ileum strangulated through a 2 X 3 cm defect in the left broad ligament of the uterus. The strangulated bowel was successfully reduced and the defect was closed with a 2-0 silk running suture. No bowel resection was required. The patient was discharged from the hospital on day 4, with no postoperative complications.