A closed loop obstruction caused by entrapment of the fallopian tube and herniation through the broad ligament. (2015)

• Record Type: Journal Article
• Authors: Cameron, Michaella; Janakan, Gnananandan; Birch, David; Nazir, Sarfraz
• Is Part Of: International journal of surgery case reports. Volume 12(2015)
• Page Start: 57
• Page End: 59
• Publication Date: 2015
• Subjects: Small bowel obstruction -- Broad ligament -- Fallopian tube -- Internal hernia; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2015.02.010
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: A double pathology caused by a broad ligament defect and entrapment of the fallopian tube around the bowel is uncommon. Computed tomography with lack of intravenous contrast can cause a pre-operative diagnostic challenge and the decision to operate needs sound clinical judgement. Rarer aetiologies of small bowel obstruction need consideration in female patients presenting with pain which is poorly localised but persistent. Obstructive causes arising within the pelvis may not necessarily result in peritonism. Abstract: A 49-year-old female presented with one week history of severe abdominal pain, vomiting and constipation. Pertinent past surgical history consisted of caesarean section, laparoscopic right fallopian tube cystectomy and myomectomy. There was also recent left mastectomy and adjuvant chemotherapy for breast carcinoma. Clinical examination established a tensely distended abdomen with scanty bowel sounds but no clinical peritonism. Blood tests showed severe acute kidney injury and raised inflammatory markers. Computed tomography without intravenous contrast demonstrated small bowel obstruction of uncertain aetiology but with likely calibre change in the pelvis. At operation, the left fallopian tube had wrapped itself around ischemic bowel. A left salpingo-oophorectomy was performed to release the bowel. On closer inspection, an internal hernia caused by a defect in the broad ligament was diagnosed. This case report describes a differential of atypical small bowel obstruction to be considered when faced with a female acute abdomen.