Broad Band Ligament Hernia Revisited (85 Cases of Allen-Master’s Syndrome; History and Perspectives)

Abstract

The purpose of this review is to update readers on the characteristics and pathogenesis of internal hernia secondary to a defect of broad ligament of the uterus. The etiopathogenesis of the disease is controversial. There are two main hypotheses to explain the generation of the defect in the ligament. The first of them would explain this entity as a result of obstetric trauma, an inflammatory pelvic disease, or gynecological surgery. However, in the absence of them, the second hypothesis would speak of congenital defects due to rupture of cysts of the ligament itself. In either case, a defect in the ligament would occur, and that would typically allow the herniation of the bowel, causing an intestinal obstruction. In addition, despite the classic tendency of conventional open surgery access as part of the treatment, laparoscopic access is today, in trained hands, a perfectly valid option. Internal hernias account for less than 1% of the total bowel obstruction cases. Those originated by a defect of the broad ligament are exceptional. A non-systematic review of the cases reported in PubMed was carried out. Eighty-seven cases were found. In them, we analyzed variables such as age, surgical or obstetric background, laterality, incarcerated content, clinical, imaging tests, need for intestinal resection, hernia type, and surgical access. Patient’s age was 1–94 years (mean 44.6 ± 15 years). The results obtained were compared with those contributed to literature by each author. Early diagnosis of this pathology is difficult and should be suspected in women with obstetric or gynecological antecedents who present with intestinal obstruction. Its treatment is mainly surgical: access to the abdominal cavity, release the incarcerated part, repair the defect (by suturing it), and, if necessary, treat the incarcerated bowel with economic resection and anastomosis. Nowadays, laparoscopic access is considered an adequate option in surgeons with proper training.