Internal Herniation of an Ovarian Endometrioma through the Fenestra of the Broad Ligament: Case Report

症例報告 子宮広間膜異常裂孔ヘルニアを伴った卵巣子宮内膜症嚢胞の一例 2014 年 30 巻 1 号 p. 247-252 詳細 抄録 Internal herniation through a fenestra of the broad ligament is very rare, and constitutes 4-7% of all internal herniations. Since common hernia content is small or large intestine, herniation of an ovary through a fenestra of the broad ligament is extremely rare; only 6 cases have been reported. We experienced a case of a broad ligament hernia of a left ovarian endometrioma. A 38 year-old woman was referred to our hospital for evaluation of infertility and an ovarian cyst. Ultrasonography and MRI imaged a lower abdominal cyst, 9.5cm in diameter, at vesicouterine pouch. Laparoscopy revealed that the left ovary passed through the defect of the left broad ligament, and an endometrioma was present in the vesicouterine pouch. The right adnexa and right broad ligament were normal. The left ovarian cyst was enucleated and the dislocation of the left ovary was corrected. The fenestra was in the peritoneal defect of the endometriotic lesion, and it was difficult to close the fenestra by suturing due to tension. After electrocoagulation, a tissue-sealing sheet was placed on both sides of the fenestra. Compared to an intestinal hernia through a fenestra of the broad ligament, an ovarian hernia is common in younger women, strongly associated with endometriosis, and is right side dominant; however, it is less associated with parity. A fenestra of the broad ligament is a potential cause of herniation; it is necessary to close the defect if it is observed or produced during surgery. Laparoscopy revealed that the left ovary passed through the defect of the left broad ligament, and an endometrioma was present in the vesicouterine pouch. The right adnexa and right broad ligament were normal. The left ovarian cyst was enucleated and the dislocation of the left ovary was corrected. The fenestra was in the peritoneal defect of the endometriotic lesion, and it was difficult to close the fenestra by suturing due to tension. After electrocoagulation, a tissue-sealing sheet was placed on both sides of the fenestra. Compared to an intestinal hernia through a fenestra of the broad ligament, an ovarian hernia is common in younger women, strongly associated with endometriosis, and is right side dominant; however, it is less associated with parity. A fenestra of the broad ligament is a potential cause of herniation; it is necessary to close the defect if it is observed or produced during surgery. © 2014 日本産科婦人科内視鏡学会