Small Bowel Obstruction Secondary to an Internal Hernia Through the Pouch of Douglas: A Case Report and Review of the Literature

Background: Internal hernias are an uncommon cause of small bowel obstruction.These are caused by the protrusion of viscera through defects in the mesentery or peritoneum.Pouch of Douglas hernias are an exceedingly rare type of internal hernia.As such, there are no standard guidelines for management. Case Presentation:An elderly female presented with small bowel obstruction in the virgin abdomen, was found to have a recto uterine cul-de-sac or pouch of Douglas hernia via a computer tomography (CT) scan.Open reduction of the hernia followed by herniotomy was the method used to treat this patient.Conclusion: Pouch of Douglas hernias are a rare type of internal hernia.It may be due to a congenital defect in the peritoneum or due to an acquired defect usually secondary to previous pelvic procedures.It may be identified via computer tomography (CT) and the definitive management is surgical due to the high risk of strangulation.Herniotomy or widening of the hernia defect, which decreases the risk of incarceration and strangulation, appears to be a valid method of definitive management of hernias within the Pouch of Douglas