Cecal Volvulus Through an Internal Hernia Created by an Elongated Fallopian Tube

Internal hernias result from abdominal viscera protruding through a congenital or acquired defect in the peritoneum or the mesentery of the abdominal cavity. They are less common than external hernias, and the overall incidence is rare. Internal hernias carry a high mortality rate if there is no immediate surgical intervention and can lead to complications such as bowel perforation, ischemia, and necrosis. There are multiple classifications, and a rare subtype identified in only a select few cases involves the fallopian tube. This case documents the development of a cecal volvulus due to the cecum herniating through an aperture created by a normal-appearing fallopian tube attaching to the retroperitoneum.  A 78-year-old female with multiple comorbidities was admitted for abdominal pain lasting 3-4 days, nausea, emesis, and poor oral tolerance. Computerized tomography imaging revealed a complete large bowel obstruction secondary to a cecal volvulus, and she was taken emergently for an exploratory laparotomy. Intra-operatively, a distended cecum was noted, herniated through a loop created by the right fallopian tube tethering its free end to the left pelvis. Upon decompression of the bowel, the fallopian tube released itself from the retroperitoneum. The cecum and right fallopian tube were noted to be ischemic and resected with an ileo-transverse anastomosis. Internal hernias that involve the fallopian tubes are a rare variation of an already uncommon condition. However, they should be included in the differential diagnosis when evaluating a female patient for intestinal obstruction since it can develop into a life-threatening condition that requires prompt surgical attention.