Richter's hernia through the broad ligament: Role of computed tomography and ultrasonography in facilitating diagnosis and rapid operative repair

Abstract

A 45-YEAR-OLD WOMAN came to the emergency department after the abrupt onset of sharp right lower quadrant abdominal pain that awoke her from sleep. She described the pain as constant with unpredictable periods of increasing severity, and she denied constitutional symptoms. Her vital signs and initial laboratory work-up were within normal limits. On physical examination, she had mild periumbilical, suprapubic, and right lower quadrant tenderness to light and deep palpation that was most severe in the right lower quadrant; however, there were no signs of peritonitis. Findings of the genitourinary examination were notable for a nontender, enlarged, and nodular uterus. As appendicitis was the greatest clinical concern, the patient underwent a computed tomography (CT) scan with oral and intravenous contrast. The scan revealed a 3-cm, round, fluid density structure in the right lower pelvis, which was contiguous with small bowel loops and abutted the right side of the uterus, which was enlarged with multiple leiomyomata (Fig 1, A). The structure was noted to have a thickened wall and was surrounded by ascites but was separate from the right ovary. On delayed acquisition performed more than 1 hour later (not shown),