Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Current Obstetrics and Gynecology Reports
Published in: Current Obstetrics and Gynecology Reports 3/2019

01-09-2019 | Laparoscopy | Urogynecology (P Nikpoor, Section Editor)

Broad Band Ligament Hernia Revisited (85 Cases of Allen-Master’s Syndrome; History and Perspectives)

Authors: Fernando Mendoza-Moreno, Enrique Ovejero-Merino, María Del Rocío Díez-Gago, Alma Blázquez-Martín, Manuel Díez-Alonso, Fernando Noguerales-Fraguas

Published in: Current Obstetrics and Gynecology Reports | Issue 3/2019

Login to get access

Abstract

Purpose of Review

The purpose of this review is to update readers on the characteristics and pathogenesis of internal hernia secondary to a defect of broad ligament of the uterus.

Recent Findings

The etiopathogenesis of the disease is controversial. There are two main hypotheses to explain the generation of the defect in the ligament. The first of them would explain this entity as a result of obstetric trauma, an inflammatory pelvic disease, or gynecological surgery. However, in the absence of them, the second hypothesis would speak of congenital defects due to rupture of cysts of the ligament itself. In either case, a defect in the ligament would occur, and that would typically allow the herniation of the bowel, causing an intestinal obstruction. In addition, despite the classic tendency of conventional open surgery access as part of the treatment, laparoscopic access is today, in trained hands, a perfectly valid option.

Summary

Internal hernias account for less than 1% of the total bowel obstruction cases. Those originated by a defect of the broad ligament are exceptional. A non-systematic review of the cases reported in PubMed was carried out. Eighty-seven cases were found. In them, we analyzed variables such as age, surgical or obstetric background, laterality, incarcerated content, clinical, imaging tests, need for intestinal resection, hernia type, and surgical access. Patient’s age was 1–94 years (mean 44.6 ± 15 years). The results obtained were compared with those contributed to literature by each author. Early diagnosis of this pathology is difficult and should be suspected in women with obstetric or gynecological antecedents who present with intestinal obstruction. Its treatment is mainly surgical: access to the abdominal cavity, release the incarcerated part, repair the defect (by suturing it), and, if necessary, treat the incarcerated bowel with economic resection and anastomosis. Nowadays, laparoscopic access is considered an adequate option in surgeons with proper training.
Literature
1.
Fonseca-Coronado R, Robles-Elias FJ, Robles-Morales R. Internal hernia to the broad ligament: report of a rare case solved with laparoscopy and review of the literature. Ginecol Obstet Mex. 2013;81(11):658–64.PubMed
2.
Toolabi K, Zamanian A, Parsaei R. Bowel obstruction caused by broad ligament hernia sucessfully repaired by laparoscopy. Ann R Coll Surg Engl. 2018;100(4):e94–e6.CrossRefPubMedPubMedCentral
3.
Reyna-Villasmil E, Prieto Montano J, Suarez-Torres I, Labarca-Acosta M. Internal hernia through a broad ligament defect. Gastroenterol Hepatol. 2015;38(10):583–4.CrossRefPubMed
4.
Simstein NL. Internal herniation through a defect in the broad ligament. Am Surg. 1987;53(5):258–9.PubMed
5.
Mersheimer WL, Kazarian KK, Roeder WJ. Internal hernia due to defects in the broad ligament: report of two cases. Rev Surg. 1973;30(4):241–5.PubMed
6.
Varela GG, Lopez-Loredo A, Garcia Leon JF. Broad ligament hernia-associated bowel obstruction. JSLS. 2007;11(1):127–30.PubMedPubMedCentral
7.
Bordenca MJ. Hernia through the broad ligament complicating pregnancy. Obstet Gynecol. 1959;13(3):311–3.PubMed
8.
9.
• Quain. Case of internal strangulation of a large portion of the ileum. Trans Pathol Soc London. 1861:103–4 This reports describes the first case of broad ligament hernia in the literature.
10.
Cameron M, Janakan G, Birch D, Nazir S. A closed loop obstruction caused by entrapment of the fallopian tube and herniation through the broad ligament. Int J Surg Case Rep. 2015;12:57–9.CrossRefPubMedPubMedCentral
11.
Haku T, Daidouji K, Kawamura H, Matsuzaki M. Internal herniation through a defect of the broad ligament of the uterus. Abdom Imaging. 2004;29(2):161–3.CrossRefPubMed
12.
Nozoe T, Anai H. Incarceration of small bowel herniation through a defect of the broad ligament of the uterus: report of a case. Surg Today. 2002;32(9):834–5.CrossRefPubMed
13.
Mustier MJ. Apropos of a case of intestinal hernia through a breach in the broad ligament. Bull Fed Soc Gynecol Obstet Lang Fr. 1964;16:377–81.PubMed
14.
Johnson GL. Intestinal obstruction secondary to a hiatus in the uterine broad ligament. Mil Med. 1965;130(10):1014–5.CrossRefPubMed
15.
Bolin TE. Internal herniation through the broad ligament. Case report. Acta Chir Scand. 1987;153(11–12):691–3.PubMed
16.
Ishihara H, Terahara M, Kigawa J, Terakawa N. Strangulated herniation through a defect of the broad ligament of the uterus. Gynecol Obstet Investig. 1993;35(3):187–9.CrossRef
17.
Vo TM, Gyaneshwar R, Mayer C. Concurrent sigmoid volvulus and herniation through broad ligament defect during pregnancy: case report and literature review. J Obstet Gynaecol Res. 2008;34(4 Pt 2):658–62.CrossRefPubMed
18.
Otani-Takei N, Akimoto T, Sadatomo A, Saito O, Muto S, Kusano E, et al. Bowel obstruction and peritoneal Dialysis: a case report of a patient with complications from a broad ligament hernia. Clin Med Insights Case Rep. 2016;9:57–60.CrossRefPubMedPubMedCentral
19.
•• Mazzetti CH, Hock N, Taylor S, Lemaitre J, Crener K, Lebrun E. Acute abdominal pain due to internal herniation of the sigmoid colon, fallopian tube and left ovary, a rare presentation of Allen Masters syndrome. Acta Chir Belg. 2018:1–3 This report is an interesting updated review of the cases of the defects of broad ligament related to hernias.
20.
Demir H, Scoccia B. Internal herniation of adnexa through a defect of the broad ligament: case report and literature review. J Minim Invasive Gynecol. 2010;17(1):110–2.CrossRefPubMed
21.
Fukuoka M, Tachibana S, Harada N, Saito H. Strangulated herniation through a defect in the broad ligament. Surgery. 2002;131(2):232–3.CrossRefPubMed
22.
Baron A. Defect in the broad ligament and its association with intestinal strangulation. Br J Surg. 1948;36(141):91–4.CrossRefPubMed
23.
Bates GJ, Bennett IC, Furnival CM, Gough IR. A strangulated hernia through the broad ligament causing ureteric obstruction. J R Coll Surg Edinb. 1983;28(5):335.PubMed
24.
Onida S, Lynes K, Ozdemir BA, Whitehouse PA. Unexpected findings at diagnostic laparoscopy: caecal incarceration with concurrent appendicitis in a patient with bilateral broad ligament defects. Ann R Coll Surg Engl. 2010;92(6):W19–20.CrossRefPubMed
25.
• Allen WM, Masters WH. Traumatic laceration of uterine support; the clinical syndrome and the operative treatment. Am J Obstet Gynecol. 1955;70(3):500–13 This reports describes the phisiopathology, signs and symptons about broad ligament defect.CrossRefPubMed
26.
Post IC, Vollebregt A, Bokani N, de Korte N. The complicated Allen-Masters syndrome: small bowel herniation through a broad ligament defect. Am J Obstet Gynecol. 2014;211(3):e3–4.CrossRefPubMed
27.
Kosaka N, Uematsu H, Kimura H, Yamamori S, Hirano K, Itoh H. Utility of multi-detector CT for pre-operative diagnosis of internal hernia through a defect in the broad ligament (2007: 1b). Eur Radiol. 2007;17(4):1130–3.CrossRefPubMed
28.
Marraoui W, Petitcolin V, Bros S, Slim K, Garcier JM, Da Ines D. Internal hernia of the broad ligament: CT diagnosis for laparoscopic management. Diagn Interv Imaging. 2012;93(7–8):621–4.CrossRefPubMed
29.
Hunt AB. Fenestrae and pouches in the broad ligament as an actual and potential cause of strangulated intra-abdominal hernia. J Surg Gynecol Obstet. 1934;58:906–13.
30.
Cilley R, Poterack K, Lemmer J, Dafoe D. Defects of the broad ligament of the uterus. Am J Gastroenterol. 1986;81(5):389–91.PubMed
31.
Matsunami M, Kusanagi H, Hayashi K, Yamada S, Kano N. Broad ligament hernia successfully treated by laparoscopy: case report and review of literature. Asian J Endosc Surg. 2014;7(4):327–9.CrossRefPubMed
32.
Guillem P, Cordonnier C, Bounoua F, Adams P, Duval G. Small bowel incarceration in a broad ligament defect. Surg Endosc. 2003;17(1):161–2.PubMed
33.
Takeyama H, Kogita Y, Nishigaki T, Yamashita M, Aikawa E, Hoshi M, et al. Broad ligament hernia successfully repaired by single-incision laparoscopy: a case report. Asian J Endosc Surg. 2018;11(3):274–6.CrossRefPubMed
34.
Denton GW, Schofield JB, Gallagher P. Uncommon complications of laparoscopic sterilisation. Ann R Coll Surg Engl. 1990;72(3):210–1.PubMedPubMedCentral
35.
Hightower CC, Hightower CC Jr. Congenital hernia of the posterior sheath of the broad ligament. Miss Doct. 1948;25(12):391.PubMed
36.
Robert HG, Margulies-Winaver D. Hernias of the intestine through tears in the broad ligament. Contribution to the study of internal hernias. Rev Fr Gynecol Obstet. 1961;56:283–98.PubMed
37.
Mathieson AJ, Millar WG. Ileovaginal fistula complicating internal hernial strangulation through a broad ligament defect. Br J Surg. 1971;58(5):353–5.CrossRefPubMed
38.
Arianoff AA, Vielle G, Gose C, Dewulf E. Obstruction by a hernia of the small intestine in an opening of the broad ligament. Acta Gastroenterol Belg. 1972;35(9):400–13.PubMed
39.
Karaharju E, Hakkiluoto A. Strangulation of small intestine in an opening of the broad ligament. Int Surg. 1975;60(8):430.PubMed
40.
Kyosola K. Simultaneous occurrence of ovarian torsion and gangrenous strangulation through a congenital opening in the mesosalpinx. Ann Chir Gynaecol. 1977;66(6):290–1.PubMed
41.
Kristiansen FV. Strangulation of the small intestine in parametrial defects. Ugeskr Laeger. 1979;141(50):3455–6.PubMed
42.
Livaudais W Jr, Hartong JM. Herniation of the small bowel through a defect in the broad ligament: case report. Mil Med. 1978;143(3):190–1.CrossRefPubMed
43.
Livaudais W Jr, Hartong JM, Otterson WN. Small bowel herniation through a defect in the broad ligament. Am J Obstet Gynecol. 1979;133(8):927–8.CrossRefPubMed
44.
Natalini G, Trancanelli V, Gerli P, Castori AC, Leone de Magistris C, Sfondalmondo S, et al. Internal hernia through an orifice of the broad ligament of the uterusMinerva Chir. 1980;35(17):1359–62.PubMed
45.
Armstrong CP, Drummond A. Small bowel obstruction and perforation through a defect in the broad ligament. J R Coll Surg Edinb. 1983;28(5):333–4.PubMed
46.
Leahy PF, Galvin C. Small bowel obstruction through a defect in the broad ligament. Ir Med J. 1984;77(11):355.PubMed
47.
Nikolajsen IL, Toft P. Herniation of the small bowel through a defect of the broad ligament. Ugeskr Laeger. 1986;148(29):1833–4.PubMed
48.
Suzuki M, Takashima T, Funaki H, Uogishi M, Isobe T, Kanno S, et al. Radiologic imaging of herniation of the small bowel through a defect in the broad ligament. Gastrointest Radiol. 1986;11(1):102–4.CrossRefPubMed
49.
Redwine DB. Symptomatic internal hernia of the broad ligament: a complication of electrocoagulation therapy of endometriosis. Obstet Gynecol. 1989;73(3 Pt 2):495–6.PubMed
50.
Ritchie AJ, Humphreys WG. Internal herniation of small bowel through a broad ligament defect. Br J Hosp Med. 1991;45(2):109.PubMed
51.
Tanaka M, Kaneko Y, Ietsugu K, Yoshida C. Internal herniation through a broad ligament defect after obturator hernia repair. Surg Today. 1994;24(7):634–7.CrossRefPubMed
52.
Fafet P, Souiri M, Ould Said H, Mattei M, Godlewski G. Internal hernia of the small intestine through a breach of the broad ligament, apropos of a case. Review of the literature. J Chir (Paris). 1995;132(6–7):314–7.
53.
Coulier B, Menten R, Ramboux A. Diagnosis using spiral computed tomography of an internal hernia through the uterine broad ligament. JBR-BTR. 1999;82(4):151–2.PubMed
54.
Kanbur AS, Ahmed K, Bux B, Hande T. Jejunal obstruction and perforation resulting from herniation through broad ligament. J Postgrad Med. 2000;46(3):189–90.PubMed
55.
Sau M, Manni P, Baccoli A, Casula G, Tuveri A. Defect of the broad ligament as a cause of internal hernia. G Chir. 2001;22(3):83–4.PubMed
56.
Chapman VM, Rhea JT, Novelline RA. Internal hernia through a defect in the broad ligament: a rare cause of intestinal obstruction. Emerg Radiol. 2003;10(2):94–5.CrossRefPubMed
57.
Le P, Chambon H, Madeuf E. Internal hernia of the broad ligament. J Chir (Paris). 2005;142(1):46–7.CrossRef
58.
Oladele AO, Oni AA, Agbakwuru FA. Internal hernia through the broad ligament presenting with acute on chronic intestinal obstruction: a case report. Niger J Med. 2006;15(4):430–1.PubMed
59.
Hiraiwa K, Morozumi K, Miyazaki H, Sotome K, Furukawa A, Nakamaru M. Strangulated hernia through a defect of the broad ligament and mobile cecum: a case report. World J Gastroenterol. 2006;12(9):1479–80.CrossRefPubMedPubMedCentral
60.
Tan GH, Harunarashid H, Das S, Goh YH, Ramzisham AR. Internal hernia through the mesosalpinx: a lesson to learn. Clin Ter. 2010;161(6):533–4.PubMed
61.
Cisse M, Ka I, Konate I, et al. Incarcerated internal hernia through a breach of the broad ligament, a case report. Gynecol Obstet Fertil. 2011;39(2):e47–8.CrossRefPubMed
62.
Barbier Brion B, Daragon C, Idelcadi O, Mantion G, Kastler B, Delabrousse E. Small bowel obstruction due to broad ligament hernia: computed tomography findings. Hernia. 2011;15(3):353–5.CrossRefPubMed
63.
Quiroga S, Sarrias M, Sanchez JL, Rivero J. Small bowel obstruction secondary to internal hernia through a defect of the broad ligament: preoperative multi-detector CT diagnosis. Abdom Imaging. 2012;37(6):1089–91.CrossRefPubMed
64.
Langan RC, Holzman K, Coblentz M. Strangulated hernia through a defect in the broad ligament: a sheep in wolf's clothing. Hernia. 2012;16(4):481–3.CrossRefPubMed
65.
Rabushka SE. Colon hernia through a hiatus in the broad ligament. Report of a case and review of the literature. Obstet Gynecol. 1968;31(2):261–5.CrossRefPubMed
66.
Gray TW, Baillie DM. Hernia of the ovary and fallopian tube into the broad ligament. Can Med Assoc J. 1933;29(6):647–8.PubMedPubMedCentral
67.
Paira SK, Nath S, Mukherjee R, Chaudhary T, Bandopadhyay SK, Ghosh PS. Herniation of a broad ligament dermoid cyst through sciatic foramen--a rare cause of gluteal swelling. J Indian Med Assoc. 2010;108(6):374–5.PubMed
68.
Delannoy E, Gautier P, Devambez J. Hernia of appendix through breach of broad ligament; operative discovery in a patient with uterine cancer, associated with calcified uterine fibroma and dermoid cyst of ovary. Bull Fed Soc Gynecol Obstet Lang Fr. 1950;2(4):439–41.PubMed
69.
Reza JA, Mohammad SK. Strangulation of the small bowel due to a defect in the broad ligamentUgeskr Laeger. 2006;168(4):390–1.PubMed
70.
Garcia-Oria M, Inglada J, Domingo J, Biescas J, Ching C. Small bowel obstruction due to broad ligament hernia successfully treated by laparoscopy. J Laparoendosc Adv Surg Tech A. 2007;17(5):666–8.CrossRefPubMed
71.
Takayama S, Hirokawa T, Sakamoto M, Takahashi H, Yamamoto M, Sato M, et al. Laparoscopic management of small bowel incarceration caused by a broad ligament defect: report of a case. Surg Today. 2007;37(5):437–9.CrossRefPubMed
72.
Agresta F, Michelet I, Candiotto E, Bedin N. Incarcerated internal hernia of the small intestine through a breach of the broad ligament: two cases and a literature review. JSLS. 2007;11(2):255–7.CrossRefPubMedPubMedCentral
73.
Leone V, Misuri D, Faggi U, Giovane A, Fazio C, Cardini S. Laparoscopic treatment of incarcerated hernia through right broad ligament in patients with bilateral parametrium defects. G Chir. 2009;30(4):141–3.PubMed
74.
Mailleux P, Ramboux A. Small bowel obstruction due to an internal herniation through a defect of the broad ligament. JBR-BTR. 2010;93(4):201–3.PubMed
75.
76.
Garcia-Oria M. Laparoscopic treatment of a hernial orifice in the broad ligament. Cir Esp. 2012;90(8):540.CrossRefPubMed
77.
Ngabou UD, Hornez E, Chiron P, Fondin M, Pons F. Internal hernia through a defect in the broad ligament. J Visc Surg. 2012;149(2):e161–2.CrossRefPubMed
78.
Bangari R, Uchil D. Laparoscopic management of internal hernia of small intestine through a broad ligament defect. J Minim Invasive Gynecol. 2012;19(1):122–4.CrossRefPubMed
79.
Garcia-Fadrique A, Sospedra Ferrer R, Vazquez Tarragon A, Martinez Abad M. Intestinal obstruction due to a hernia across the broad ligament of the uterus. Cir Esp. 2012;90(2):e5.CrossRefPubMed
80.
Vyrdal CD, El-Hussuna A. Laparoscopically treated small bowel obstruction due to internal herniation through the broad ligament. Pol Przegl Chir. 2014;86(8):377–9.CrossRefPubMed
81.
Rodrigues F, Sarmento I, Tiago P. Asymptomatic internal hernia through a defect of broad ligament: a surprising finding in a laparoscopic surgery to recover a lost levonorgestrel-releasing intrauterine system. BMJ Case Rep. 2015;2015.
82.
Bailey CR, Leeper WR, Johnson PT, Berlanstein BP, Fishman EK, Coquia SF. Richter's hernia through the broad ligament: role of computed tomography and ultrasonography in facilitating diagnosis and rapid operative repair. Surgery. 2016;159(3):975–7.CrossRefPubMed
83.
Lo K, Lie K. Internal herniation through a broad ligament defect found at laparoscopy. J Obstet Gynaecol Can. 2013;35(5):401.CrossRefPubMed
84.
Hassadia A, Saha A. Bilateral herniation of the ovaries into the anterior compartment of the pelvis. J Minim Invasive Gynecol. 2011;18(1):9.CrossRefPubMed
85.
El Madi A, Khattala K, Rami M, Bouabdallah Y. Hernia of the bladder through the broad ligament with renal agenesis and ipsilateral ureter blind ending. Pan Afr Med J. 2014;18:218.9.
Metadata
Title
Broad Band Ligament Hernia Revisited (85 Cases of Allen-Master’s Syndrome; History and Perspectives)
Authors
Fernando Mendoza-Moreno
Enrique Ovejero-Merino
María Del Rocío Díez-Gago
Alma Blázquez-Martín
Manuel Díez-Alonso
Fernando Noguerales-Fraguas
Publication date
01-09-2019
Publisher
Springer US
Published in
Current Obstetrics and Gynecology Reports / Issue 3/2019
Electronic ISSN: 2161-3303
DOI
https://doi.org/10.1007/s13669-019-0260-z

Other articles of this Issue 3/2019

Current Obstetrics and Gynecology Reports 3/2019 Go to the issue

Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)

Multidisciplinary Teams in the Management of Placenta Accreta Spectrum Disorders

Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)

From Etiopathology to Management of Accreta Placentation

Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)

Managing Placenta Accreta Spectrum Disorders (PAS) in Middle/Low-Resource Settings

Environmental Exposures and Pregnancy Outcomes (N Grindler, Section Editor)

Paternal Environmental Toxicant Exposure and Risk of Adverse Pregnancy Outcomes

Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)

Is There a Role for MRI in the Management of Placenta Accreta Spectrum?

Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)

Prenatal Ultrasound Imaging for Placenta Accreta Spectrum (PAS): a Practical Guide