Internal hernia through a congenital peritoneal defect in the vesico-uterine space

Area of Science:

• Gastroenterology
• Surgical Anatomy
• Abdominal Surgery

Background:

• Internal hernias are rare causes of small bowel obstruction (SBO), often resulting from congenital or acquired mesenteric defects.
• Diagnosis of SBO secondary to internal hernia is challenging due to non-specific clinical presentations.
• Internal hernias require consideration in the differential diagnosis for patients presenting with SBO.

Purpose of the Study:

• To report the first case of SBO caused by an internal hernia through the vesico-uterine space.
• To emphasize the clinical significance of rare congenital pelvic peritoneal defects in causing bowel obstructions.

Main Methods:

• Case presentation of a 38-year-old female with SBO.
• Diagnostic workup included exploratory laparoscopy.
• Surgical management involved freeing incarcerated bowel and closing a peritoneal defect.

Main Results:

• A diagnosis of internal hernia through a congenital vesico-uterine peritoneal defect was made.
• Laparoscopic surgery successfully released the incarcerated bowel.
• The patient experienced complete resolution of obstructive symptoms post-operatively.

Conclusions:

• This is the first reported case of intestinal obstruction due to herniation through a congenital vesico-uterine peritoneal defect.
• Congenital pelvic peritoneal defects, though rare, can lead to significant bowel obstructions.
• Awareness of these rare defects is crucial for surgical diagnosis and management.