Introduction: Internal hernias are a rare cause of intestinal obstruction and may present as intermittent subocclusive episodes. Retro-uterine hernias are exceptionally rare in adults. Early diagnosis is essential to prevent intestinal ischemia.Clinical Observation: We report the case of a 41-year-old female with recurrent subocclusive episodes since childhood, who presented with acute intestinal obstruction characterized by cessation of flatus and stool, abdominal distension, and vomiting. Imaging revealed an abrupt transition zone in the pelvis with dilation of proximal small bowel loops and distal ileal collapse.Operative Findings: An emergency laparotomy identified a retro-uterine internal hernia containing viable small bowel loops without signs of ischemia. A small hematic peritoneal effusion was present. Adhesiolysis and hernia reduction were performed, along with biopsy of a retro-uterine nodule.Discussion: Retro-uterine internal hernias are rare but should be considered in cases of recurrent subocclusive episodes. Computed tomography (CT) remains the gold standard to locate and characterize the hernia 4,6. Cases published by Hari et al. demonstrate the feasibility of laparoscopic treatment 7, while Rabai et al. emphasize the possible anatomical complexity with double hernia orifices and associated pathology (peritoneal xanthogranuloma) 8. Rare pelvic hernias such as Lindbom’s or ureterosciatic hernias constitute important differential diagnoses 9.Conclusion: Retro-uterine internal hernias are a rare but significant cause of intestinal obstruction. High suspicion, rapid imaging, and early surgical intervention are essential to prevent strangulation and intestinal ischemia.
Abdelhak et al. (Tue,) studied this question.