Broad ligament defect internal hernia: a rare cause of bowel obstruction in pregnancy

Internal herniation through the broad ligament is an exceptionally rare cause of small bowel obstruction (SBO), particularly in pregnant patients, and is often misdiagnosed due to non-specific clinical manifestations. This is a 35-year-old woman at 9 weeks' gestation, medically free, presented to the emergency department with abdominal pain associated with persistent vomiting. Despite conservative management, the patient was deteriorating. Therefore, a patient-shared decision for diagnostic laparoscopy was performed. Intraoperatively, a reduced viable loop of distal ileum was herniated through a defect in the right broad ligament. The postoperative course was uneventful. The persistence of clinical deterioration despite conservative therapy should prompt urgent surgical evaluation, and when indicated, laparoscopy is considered safe in pregnancy and provides diagnostic and definitive management. This case emphasizes that signs of SBO should have a low threshold for early multidisciplinary evaluation, and timely diagnostic laparoscopy is crucial to prevent delayed diagnosis and adverse maternal-fetal outcomes.