2011, Number 4
Perinatol Reprod Hum 2011; 25 (4)
Laparoscopic treatment of an intestinal obstruction due to internal hernia in the broad ligament. Report of two cases
Varela-Gutiérrez G, Herrera-Meillón H
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ABSTRACTWe present the cases of two female patients: the first one with 29 years of age and a history of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. She was admitted to the Emergency Room (ER) with a transfictive epigastric pain, irradiated to both upper quadrants and the lumbar region, accompanied by nausea and gastrobiliary vomit. Lipase determination was 170 mg/dL, plain abdominal films on patient’s admission were normal and computed tomography (CT) showed images compatible with acute pancreatitis. Further abdominal x-rays revealed dilatation of small bowel loops. Intestinal obstruction treatment was initiated, with intravenous hydration and nasogastric tube placement without good results and 48 hours later, a diagnostic laparoscopy was carried out, finding a 3 cm internal hernia in the left broad ligament (defect type 1) where a 20 cm of terminal ileum was encased. We performed laparoscopic liberation of the ileal segment and closed the hernia with the patient experiencing significant improvement. The second patient, a 38 year old woman, admitted to the ER with pain in the lower quadrants of the left iliac fossa predominance, in their history include: an appendectomy, four Caesarean sections, right inguinal hernia and four ureteroscopic procedures for urolithiasis. Abdominal radiographs and CT at admission showed dilated loops of distal small intestine in the lower abdomen corresponding to a partial blockage of the small intestine. Surgical findings were: hernia of 2 cm in the left broad ligament (fault type 1) with 90 cm segment of terminal ileum incarcerated. The surgical management of both patients was laparoscopic with release of the obstruction and there was no evidence of ischemia. The defect was closed with sutures with proper development.