Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2023; 11(5): 1182-1187
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1182
Closed loop ileus caused by a defect in the broad ligament: A case report
Isabel Zucal, Christian A Nebiker
Isabel Zucal, Christian A Nebiker, Department of General Surgery, Cantonal Hospital of Aarau, Aarau 5001, Switzerland
Author contributions: Zucal I and Nebiker CA performed the research, analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Isabel Zucal, MD, Postdoc, Department of General Surgery, Cantonal Hospital of Aarau, Tellstrasse 25, Aarau 5001, Switzerland. isabel.zucal@ksa.ch
Received: November 8, 2022
Peer-review started: November 8, 2022
First decision: November 22, 2022
Revised: December 23, 2022
Accepted: January 16, 2023
Article in press: January 16,2023
Published online: February 16, 2023
Abstract
BACKGROUND

Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity. Only a few cases have been reported in the literature.

CASE SUMMARY

We present the case of a 44-year-old, healthy patient with no prior history of abdominal surgery who developed a closed loop ileus due to an internal hernia secondary to a defect in the right broad ligament. She first presented to the emergency department with diarrhea and vomiting. As she had had no previous abdominal surgery, she was diagnosed with probable gastroenteritis and discharged. The patient subsequently returned to the emergency department due to a lack of improvement in her symptoms. Blood tests showed an elevated white blood cell count and a closed loop ileus was diagnosed on an abdominal computer tomography scan. Diagnostic laparoscopy revealed an internal hernia entrapped in a 2 cm large defect in the right broad ligament. The hernia was reduced and the ligament defect was closed using a running, barbed suture.

CONCLUSION

Bowel incarceration through an internal hernia may present with misleading symptoms and laparoscopy may reveal unexpected findings.

Keywords: Broad ligament, Ileus, Internal hernia, Laparoscopy, Case report

Core Tip: In young patients with negative history of abdominal surgery presenting at the emergency department with nausea and vomiting, the initial differential diagnosis should include ileus. If an ileus is suspected, computer tomography and laparoscopy are the diagnostic tools of choice. Internal hernias are rare, especially those through the broad ligament, but they should be considered to avoid complications such as bowel necrosis. Because of the rarity of the conditions, there are no studies or long-term data on the best treatment option, but most authors describe a direct defect closure.