177 Broad Ligament Hernia: Two Contrasting Ways to a Common Goal – Two Case Reports

Abstract

Abstract Introduction Broad ligament hernia (BLH) is a rare but potentially life-threatening condition. One of the two cases described here is the only reported case of BLH in recent literature, where marsupialization was done. These two case reports comprise the only reported side-by-side pictorial comparison of the two laparoscopic surgical therapeutic options for BLH. Presentation of cases Both patients presented with classical symptoms and signs of acute intestinal obstruction. Imaging confirmed obstructed left BLH in case 2 and indicated a complete small bowel obstruction in case 1. Both cases were successfully managed laparoscopically. Both patients had an uneventful immediate postoperative recovery and have not had recurrence over a mean follow-up period of 34.5 months. Discussion BLH is rare among all types of internal herniae. It accounts for only 4% of internal herniae and is a difficult condition to diagnose. The advent of computed tomography has increased the chances of accurate preoperative diagnosis. Conclusion BLH can be successfully managed by minimally invasive surgery, even in the acute setting. When tightly entrapped bowel is unyielding; it is better not to risk injury to it by aggressive attempts at its reduction. It is safer to attempt widening of the defect into which it is entrapped, whenever feasible.