Broad Ligament Herniation with Adnexal Cyst Causing Small Bowel Obstruction: Case Report, Review, and Considerations

Background: Broad ligament hernia is an extremely rare type of internal hernia, accounting for approximately 4% of all internal hernias. The precise mechanism responsible for defect formation remains unclear. Clinical presentation is nonspecific, which may lead to fatal outcomes, and the diagnosis is most often made intraoperatively. Several studies have reported successful preoperative diagnosis, enabling a laparoscopic approach; however, the paucity of such cases makes preoperative diagnosis challenging.Purpose: This report describes a case of small bowel obstruction caused by a broad ligament hernia and provides a review of the literature with clinical considerations.Case: A-38 year-old multiparous woman was admitted to the emergency department with abdominal pain and distension for three days. The patient had no specific medical or surgical history. The patient's abdominal radiography suggested an ileus. Exploratory laparotomy revealed a strangulated ileum through a mesosalpinx defect with an incidental 10 × 8 × 6 cm adnexal cyst. Surgical management included hernia repair, salpingo-oophorectomy, and ileostomy due to compromised mesoileal viability. Histopathological examination demonstrated a hemorrhagic cyst consistent with endometriosis.Conclusion: Broad ligament hernia, although a rare case, can be treated better if recognized early. Routine CT for unexplained ileus may improve preoperative diagnostic accuracy. During surgery, routine contralateral exploration is recommended to reduce the risk of recurrence. Finally, an adnexal cyst of considerable size may predispose to defect development and torsion, and thus should be excised.