Situs inversus totalis with bilateral broad ligament defects identified during laparoscopic surgery: a case report

Peritoneal defects of the broad ligament of the uterus are uncommon anatomical abnormalities that may be congenital or acquired. Situs inversus totalis is a congenital condition characterized by a complete mirror-image arrangement of the thoracic and abdominal organs. We report what appears to be the first case in which bilateral peritoneal defects of the broad ligament were incidentally identified in a patient with situs inversus totalis during laparoscopic surgery performed for suspected endometrial cancer.

A 71-year-old Japanese woman with a known history of situs inversus totalis presented to a local clinic with abnormal uterine bleeding. Endometrial cytology yielded suspicious findings and endometrial biopsy revealed atypical glands. Imaging studies demonstrated a small intrauterine mass without deep myometrial invasion or evidence of distant spread. Based on the combined findings of imaging, cytology, and biopsy, endometrial cancer was strongly suspected, and laparoscopic total hysterectomy with bilateral salpingo-oophorectomy was performed. Intraoperatively, bilateral peritoneal defects involving both layers of the broad ligament were identified immediately beneath the uterine round ligaments. Despite mirror-image anatomical variation, which has been reported to increase technical difficulty in laparoscopic surgery, the procedure was completed safely with careful anatomical confirmation. The operative time was 141 min, blood loss was minimal, and the postoperative course was uneventful. The patient was discharged on postoperative day 6, in accordance with our institutional postoperative management protocol. Histopathological examination revealed endometrioid carcinoma (grade 1), FIGO stage IA. No adjuvant therapy was administered, and the patient has remained free of recurrence to date.

To our knowledge, this is the first reported case in which situs inversus totalis and bilateral peritoneal defects of the broad ligament were simultaneously identified during laparoscopic surgery. Although rare, peritoneal defects of the broad ligament can cause an internal hernia leading to bowel obstruction or strangulation; therefore, awareness of this condition and its characteristic imaging findings is essential, particularly when considering the differential diagnosis of acute abdomen in patients without a history of abdominal surgery.