A rare case of Pouch of Douglas hernia- Atypical presentation in a postnatal mother

Abirami  Mahadevan; Divya Sugumaran; Ramprasad Jothimani

doi:10.5455/ajdi.20240719061515

Abstract
Background:
Internal hernias are quite rare which constitutes right and left paraduodenal, trans-mesenteric hernia and pelvic hernias.

Case presentation:
23 year old female postnatal mother delivered 4 months back, IUCD was inserted post delivery now presented with C/O greenish discharge PV and vaginal fullness. Ultrasound showed few dilated small bowel loops.Computed tomography revealed multiple dilated fluid filled small bowel loops suggestive of subacute small bowel obstruction. Herniation of the small bowel loops into the POD is noted.MRI revealed the small bowel loops in POD herniating through fornix into the vagina. Intraoperatively , small bowel loops were seen herniating through a defect in the POD on the right side into the fornix and formed a sac within the vagina. A sealed perforation was seen within the herniated loop and short segment gangrene was identified. Resection and anastomosis of bowel loop along with closure of defect in broad ligament defect was done.
Conclusion:
Pelvic hernia through the defect in cul-de-sac is very rare and high clinical suspicion is needed to diagnose this rare condition. Radiological knowledge of this rare entity in a patient with small bowel obstruction aids in early diagnosis and intervention avoiding the complications of bowel ischemia.

Key words: Pouch of Douglas, Internal hernia, small bowel obstruction