A rare cause of bowel obstruction: internal hernia through a congenital defect of the broad ligament in a young woman – a case report

Abstract

Introduction: Internal herniation through the broad ligament is an exceptionally rare cause of small bowel obstruction, representing less than 5% of internal hernias. It typically occurs in multiparous women with a history of pelvic surgery, particularly caesarean sections. Case Presentation: We report the case of a 24-year-old woman with no previous medical or surgical history who presented with acute abdominal pain and vomiting. A CT scan demonstrated a distended pelvic small bowel loop with signs of a closed-loop obstruction. Diagnostic laparoscopy revealed an ileal loop incarcerated through a congenital fenestration of the broad ligament. The incarcerated segment was viable after reduction, and the defect was closed. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. Discussion: Broad-ligament internal hernias are extremely rare and are often congenital in young women without prior pelvic surgery. Preoperative diagnosis remains difficult due to non-specific symptoms and imaging findings. Early surgical intervention, preferably laparoscopic, is essential to avoid strangulation and reduce morbidity. Conclusion: Broad-ligament internal hernias should be considered in young women presenting with small bowel obstruction, even in the absence of prior obstetric or gynecologic surgery. Early recognition and prompt surgical management are key to preventing bowel ischemia.