PMC4978204_01
Abdominal X-ray showing mildly dilated loops of the bowel without fecal impaction.
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Upright radiography showed some loops of dilated bowel with air-fluid levels (Fig. 1).
(A) Contrast-enhanced CT showing the point of discontinuity in the small bowel in the pelvic cavity (arrow) and the collapsed distal ileal loops (arrowhead). (B) Scan at a slightly more cephalic position, revealing the swirling or centralizing of the mesenteric vessels and folds toward the point of the small bowel obstruction (arrow).
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However, computed tomography (CT) of the abdomen, which was performed 2 days after admission, demonstrated discontinuity of the small bowel with a distended closed loop in the pelvic cavity (Fig. 2), suggesting that strangulation was the likely cause of the development of the bowel obstruction.
Findings of exploratory laparotomy. The schematic representation (A) shows the anatomy of the small bowel herniation (arrowhead) through a defect of the broad ligament of the uterus. A macroscopic view of the entrapped bowel (B) reveals the 10 cm of incarcerated bowel with slight edematous change (arrowhead). After freeing the small bowel (C), the defect of the broad ligament (arrowhead) was closed.
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She was therefore subjected to an exploratory laparotomy, which revealed incarcerated, small bowel herniation into the pouch of Douglas through a defect of the residual broad ligament of the uterus (Fig. 3A). Ten centimeters of the incarcerated bowel was slightly edematous (Fig. 3B); however, it was not ischemic and the entrapped bowel was freed using a bowel forceps, while the defect of the broad ligament was closed (Fig. 3C).