title: A closed loop obstruction caused by entrapment of the fallopian tube and herniation through the broad ligament.
abstract: A 49-year-old female presented with one week history of severe abdominal pain, vomiting and constipation. Pertinent past surgical history consisted of caesarean section, laparoscopic right fallopian tube cystectomy and myomectomy. There was also recent left mastectomy and adjuvant chemotherapy for breast carcinoma. Clinical examination established a tensely distended abdomen with scanty bowel sounds but no clinical peritonism. Blood tests showed severe acute kidney injury and raised inflammatory markers. Computed tomography without intravenous contrast demonstrated small bowel obstruction of uncertain aetiology but with likely calibre change in the pelvis. At operation, the left fallopian tube had wrapped itself around ischemic bowel. A left salpingo-oophorectomy was performed to release the bowel. On closer inspection, an internal hernia caused by a defect in the broad ligament was diagnosed. This case report describes a differential of atypical small bowel obstruction to be considered when faced with a female acute abdomen.
authors.affiliation: Foundation Year Two Doctor, General Surgery, University Hospital Lewisham, London, United Kingdom. Electronic address: michaella.cameron@nhs.net.
authors.forename: Michaella
authors.initials: M
authors.lastname: Cameron
authors.affiliation: ST4 General Surgery, Queen Elizabeth Woolwich, Surgery, Stadium Road, London, United Kingdom,. Electronic address: drjanakan@gmail.com.
authors.forename: Gnananandan
authors.initials: G
authors.lastname: Janakan
authors.affiliation: Consultant General Surgeon, University Lewisham Hospital, London, United Kingdom. Electronic address: dbirch1@nhs.net.
authors.forename: David
authors.initials: D
authors.lastname: Birch
authors.affiliation: Consultant Radiologist, John Radcliffe Hospital, Oxford, United Kingdom. Electronic address: Sarfraz.Nazir@ouh.nhs.uk.
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Nazir
keywords: Broad ligament; Fallopian tube; Internal hernia; Small bowel obstruction