Preoperative Diagnosis and Indocyanine Green (ICG) Fluorescence-Guided Surgery for Uterine Broad Ligament Hernia: A Case Report.

Uterine broad ligament hernia is a rare cause of bowel obstruction in women, often challenging to diagnose preoperatively. We report a case of a 73-year-old woman presenting with abdominal pain and vomiting. CT imaging revealed an incarcerated small bowel loop within the Douglas pouch, with displacement of the uterus, leading to a diagnosis of strangulated bowel obstruction due to a broad ligament hernia. An emergency laparotomy identified an ileal segment trapped in a defect of the left broad ligament. The bowel appeared ischemic, but intraoperative indocyanine green (ICG) fluorescence imaging confirmed adequate perfusion, allowing for preservation without resection. The hernial defect was repaired, and the patient recovered without complications. This case highlights the importance of early CT diagnosis and the utility of ICG fluorescence imaging in assessing bowel viability, aiding surgical decision-making, and preventing unnecessary resection in cases of prolonged strangulation.