# When Gynecological Anatomy Becomes a Surgical Emergency: A Rare Internal Hernia Case

## TL;DR

A rare case of internal hernia through the broad ligament in a woman without abdominal surgery history led to severe bowel obstruction requiring emergency surgery.

## Contribution

Highlights the diagnostic challenge and management of a rare broad ligament hernia in a female patient with no prior abdominal surgery.

## Key findings

- Internal hernia through the broad ligament can present as severe bowel obstruction without prior surgical history.
- Ultrasound findings were minimal, leading to delayed diagnosis until surgical exploration.
- Prompt surgical intervention is crucial to prevent bowel necrosis and reduce mortality.

## Abstract

Internal hernias represent an uncommon etiology of small bowel obstruction (SBO). Among these, herniation through a defect in the broad ligament is one of the least common types. Because symptoms are vague and imaging findings are often minimal, these presentations can be easily overlooked and may progress to bowel ischemia or gangrene. A 47-year-old multiparous woman with no history of abdominal surgery presented to the emergency department with severe, worsening abdominal pain that developed over the past 12 hours. Ultrasound was the only imaging modality available. It detected free fluid in the abdomen but did not identify a specific organ abnormality. The clinical team initially proceeded with an open appendicectomy, which was subsequently converted to an exploratory laparotomy. During the procedure, they identified an internal hernia that had passed through a defect in the left broad ligament. Approximately 25 cm of the necrotic bowel was resected, and the remaining segments were joined with a primary anastomosis. Postoperatively, the patient recovered without incident and was discharged home once her bowel function resumed. While broad ligament hernias are exceedingly rare, they should be kept in mind as a possible explanation for obstruction in females who have not undergone pelvic surgery. Preoperative diagnosis is frequently missed because of subtle imaging clues and the infrequency of the disease in everyday practice. When advanced radiology is limited or inconclusive, surgical exploration remains the most reliable route to both identify the problem and provide timely treatment. Although rare, broad ligament hernias should be considered in female patients presenting with SBO and no prior abdominal operations. Prompt recognition and surgical intervention are vital to minimize morbidity and mortality.