Internal Hernia through a Peritoneal Defect of the Pouch of Douglas: A Case Report

An internal hernia is a rare cause of small bowel obstruction, ranging from 0.5% to 4.1% of all hernia cases (1). This condition is rarely diagnosed preoperatively because of the nonspecific signs and symptoms. An internal hernia may be congenital or acquired as well as persistent or intermittent. More than 50% of internal hernias reported in the literature are paraduodenal (left and right), while the other types are quite rare (1, 2). Pelvic internal hernias include hernias through the broad ligament, perirectal fossa, and pouch of Douglas (1). An internal hernia through a peritoneal defect of the pouch of Douglas is extremely rare, with only two cases reported in the English literature to date (3, 4). We report a case of small bowel obstruction due to an internal hernia through a peritoneal defect of the pouch of Douglas in a 25-year-old woman with computed tomography (CT) findings, which correlated with the intraoperative findings and review of previous reports.