Small bowel obstruction due to internal herniation of jejunum through a congenital defect in the falciform ligament in a primigravida

Abstract

Small bowel obstruction due to internal herniation of jejunum through a congenital defect in the falciform ligament is a rare occurrence. Literature search shows not more than 14 cases of internal herniation of the small bowel through a congenital defect of the falciform ligament; and there are no reports of challenges faced in the diagnosis of herniation in pregnant patients. Here, we describe a rare case of internal hernia which posed significant diagnostic dilemma as the patient was 20 weeks primigravida. With restriction on the use of imaging tools, diagnosis of small bowel obstruction due to internal herniation through the falciform ligament was done by combining clinical findings with magnetic resonance imaging (MRI) and laparoscopy. The intestinal obstruction was resolved laparoscopically. The recovery was uneventful and the patient was discharged on postoperative day 4. The diagnosis of internal hernia as a cause of intestinal obstruction is usually difficult especially in the pregnant patient. However, careful examination and appropriate investigations will suggest the diagnosis which if promptly treated would be attended by a satisfactory outcome.