title: Internal hernia through a congenital peritoneal defect in the vesico-uterine space.
abstract: BACKGROUND
  An internal hernia is a rare type of hernia that may either be congenital or acquired in etiology. Acquired internal hernias generally develop from mesenteric defects or adhesions from prior surgery. These hernias can trap and/or twist small bowel, resulting in bowel obstruction. The diagnosis of small bowel obstruction (SBO) secondary to internal hernia is particularly challenging given its non-specific clinical presentation. Thus, it is critical for the clinician to keep internal hernias as part of the differential for a patient presenting with SBO.
  
  
  METHODS
  In this case, we present the first reported case of a hernia through the vesico-uterine space as a cause of an SBO. Our patient was a 38-year-old female with no past medical or surgical history who presents with nausea, vomiting, and obstipation. Upon exploratory laparoscopy, she was found to have an internal hernia through a peritoneal defect in the vesico-uterine space.
  
  
  CONCLUSIONS
  To our knowledge this is the first report of an intestinal obstruction caused by herniated bowel through a congenital vesico-uterine peritoneal defect. It is important for surgeons to keep in mind that while rare, congenital pelvic peritoneal defects can lead to bowel obstructions.
  
  
  CONCLUSIONS
  The patient underwent laparoscopic exploration, during which the incarcerated bowel was freed and appeared to be viable. The peritoneal defect was subsequently closed. Post-operatively, she recovered without issues and her obstructive symptoms resolved.
authors.affiliation: Brigham and Women's Hospital, Department of Surgery, 75 Francis St., Boston, MA, 02115, United States. Electronic address: dmou2@partners.org.
authors.forename: Danny
authors.initials: D
authors.lastname: Mou
authors.affiliation: Brigham and Women's Hospital, Department of Surgery, 75 Francis St., Boston, MA, 02115, United States. Electronic address: aseshadri@partners.org.
authors.forename: Anupamaa
authors.initials: A
authors.lastname: Seshadri
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States. Electronic address: mfallon7@partners.org.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fallon
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States. Electronic address: rthummalapalli@partners.org.
authors.forename: Rohit
authors.initials: R
authors.lastname: Thummalapalli
authors.affiliation: Brigham and Women's Hospital, Department of Surgery, 75 Francis St., Boston, MA, 02115, United States. Electronic address: raskari@partners.org.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
keywords: Internal hernia; Peritoneal defect; Small bowel obstruction; Vesico-uterine space