Broad Ligament Hernia Causing Small Bowel Obstruction: When Gynecologic Symptoms Conceal Surgical Emergencies-A Case Report.

Internal hernias are an uncommon cause of small bowel obstruction (SBO), accounting for approximately 1% of cases. Among these, broad ligament hernias represent a rare subtype, comprising approximately 4% of internal hernias. Despite their rarity, they carry a significant risk of bowel strangulation and ischemia, necessitating prompt recognition and surgical intervention. We report the case of a 35-year-old G5P3023 woman with no prior abdominal surgeries who presented with a 2-day history of sharp abdominal pain, nausea, and vomiting. Initial imaging findings were suggestive of a tubo-ovarian abscess (TOA); the patient was managed with broad-spectrum antibiotics and subsequently underwent an unsuccessful image-guided drainage attempt. Due to clinical deterioration, a diagnostic laparoscopy was performed, revealing a broad ligament hernia with incarcerated small bowel. The procedure was converted to an exploratory laparotomy, during which the ischemic ileum was resected and a primary was anastomosis performed. The broad ligament defect was subsequently repaired. This case highlights the diagnostic challenges associated with internal hernias, particularly when presentation mimics gynecologic pathology. Failure to include internal hernias in the differential diagnosis may delay appropriate intervention. Early recognition based on clinical and radiologic findings is critical to improving outcomes and preventing bowel compromise.