A Case of Intestinal Hernia Through a Hiatus in the Uterine Broad Ligament：Chronological Changes on Computed Tomography

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  • CTで経時的変化を認めた子宮広間膜裂孔ヘルニアの1例
  • CT デ ケイジテキ ヘンカ オ ミトメタ シキュウ ヒロママクレツコウ ヘルニア ノ 1レイ

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<p>A 55-year-old woman with a history of having undergone a caesarean section visited us complaining of abdominal pain. Contrast-enhanced computed tomography showed a single loop of dilated small bowel in the pelvic cavity compressing the uterus and rectum. We diagnosed the patient as having simple intestinal obstruction and undertook conservative treatment. The abdominal pain improved transiently, but recurred immediately after the patient resumed eating. Contrast-enhanced computed tomography showed a closed loop of small intestine in the pelvic cavity compressing the uterus and rectum, and a converging image of congested mesentery in the vicinity. We made the diagnosis of incarcerated hiatal hernia and performed emergency laparoscopic surgery. Intra-abdominal examination revealed a slightly reddened small intestine incarcerated through the hiatus of the left broad ligament. The incarceration was released, and the hiatus in the broad ligament was sutured closed. No resection of the incarcerated small intestine was necessary. The patient had an uneventful postoperative course and was discharged home on postoperative day 6. Intestinal hernia through a hiatus in the uterine broad ligament should be included in the differential diagnosis in women who have been pregnant or have had a caesarean section, in whom computed tomography shows evidence of small bowel obstruction in the pelvis, with the obstructed segment compressing the uterus or rectum.</p>

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