Abstract
Torsion of ovarian cyst is a common cause of acute abdomen especially in women of reproductive age-group. It commonly presents with colicky abdominal pain associated with nausea and vomiting. It could however mimic acute intestinal obstruction. The patient was a 32-year-old multipara with no previous history of pelvic or abdominal surgery. She was admitted with colicky lower abdominal pain associated with repeated episodes of vomiting and nausea. Laboratory investigations were essentially normal. Abdominopelvic USS showed a hypoechoic mass lesion in the left adnexium measuring 7.1 × 5.5 cm; surrounding bowel loops were hypoactive, dilated, and fluid filled. Diagnosis of acute abdomen secondary to suspected torsion of ovarian cyst was made. Management began for acute abdomen with intravenous hydration, prophylactic antibiotics, and analgesics. An emergency laparotomy revealed about 6 cm defect in the left broad ligament in which a 20 cm segment of terminal ileum was encased. Liberation of the ileal segment was done and the broad ligament defect closed. Bowel obstruction requires high index of suspicion in a patient with acute abdomen due to suspected torsion ovarian cyst most especially in the absence of previous pelvic or abdominal surgery.
Highlights
Intestinal obstruction occurring from internal hernia is very rare, with a reported incidence between 0.2% and 0.8% [1, 2]
Internal hernia is responsible for about 0.9% of intestinal obstruction
Hernia of the broad ligament is extremely rare and accounted for less than 7% of all internal hernias
Summary
Intestinal obstruction occurring from internal hernia is very rare, with a reported incidence between 0.2% and 0.8% [1, 2]. Adnexal torsion can occur in young girl [5] and is increasingly recognized as a cause of pelvic pain in postmenopausal women but is still most common in the reproductive years because of the regular development of a corpus luteal cyst during the menstrual cycles [6]. Adnexal torsion often can be a challenging diagnosis to make, because the classic symptoms of severe, sharp unilateral abdominal pain and nausea may not be present [7] and occasionally mimic exactly intestinal obstruction most especially in women with previous abdominal of pelvic surgery. Small bowel herniation through a defect in the broad ligament (Figure 1) could be a close differential of an adnexal torsion and clinical diagnosis before surgery may be extremely difficult
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