Quain hernia, the urgency of the unlikely

Abstract text (incl. references and figure legends)

Case history:We present the case of 68-year-old woman who has internal hernia secondary to a parametrial defect. She attended the emergency department for abdominal pain associated with vomiting for 72 hours.Clinical findings: The abdomen was distended, diffusely painful, with no peritonism. Nasogastric tube with 400cc intestinal debit.Investigation/Results:CT scan: Diffuse dilatation of practically all small bowel loops with change in calibre at right pelvic margin level, related to mechanical obstruction.Diagnosis/Therapy: She was taking to theatre with evidence of dilatation of the small bowel loops with change of calibre at pelvic level secondary to internal hernia formed by small bowel loops and hernial orifice in the right parametrium. Section of the ring at the level of the hernial orifice in the right parametrium, release of the small loop, which is undamaged, and its preservation was confirmed with indiocyanine green. Closure of the hernial orifice.Progressions:Postoperative evolution without incident.Comments:The broad ligament of the uterus consists in the two peritoneal layers covering the surface of the uterus. A defect can occur in both, most because of a congenital anomaly but also after birth trauma, surgery or pelvic inflammatory disease. Quain hernia through a defect in parametrium is extremely rare, representing less than 7% of all internal hernias being the ileum the structure involved in most occasions. More than 80% happened in multiparous or previously operated woman. The diagnosis is complex: patients do not usually present with a typical and striking clinical picture, but rather debut with non-specific abdominal pain that can make the diagnosis go unnoticed. CT or ultrasound scans can be useful. In conclusion, it is essential to make an early diagnosis when internal hernia is suspected in order to carry out early surgical treatment and reduce morbidity and mortality.References:doi:10.1016/0002-9378(79)90315-6.DOI: 10.1016/j.ijscr.2021.106599

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