Strangulated Transmural Hernia of the Uterus After Myomectomy: A Rare Cause of Bowel Obstruction

Abstract

Consultation for mechanical bowel obstruction is one of the most common reasons in emergency and surgical departments. Transmural hernia of the strangulated uterus after myomectomy is a rare etiology of intestinal obstruction. Their diagnosis is increasingly complex and is discovered during an exploratory laparotomy. In this observation, we report the case of this 34-year-old patient with a history of myomectomy, nulliparous admitted for persistent abdominal pain and vomiting. an abdominopelvic ultrasound showed images of uterine myomas in necrobiosis. the patient presented an occlusive syndrome for which an abdominopelvic MRI which confirmed the diagnosis of aseptic necrobiosis. This unusual image mimicking that of a necrobiosis of uterine myoma was the difficulty which allowed this diagnostic error and the delay in the treatment of this patient. As this philosophy emphasizes (never let the sun rise or set in case of mechanical obstruction of the small intestine). Given the persistence of clinical signs, an abdominal CT scan was requested and confirmed the diagnosis of occlusive syndrome. conclusion: Faced with the diagnosis of an acute intestinal obstruction following a myomectomy by a combination of persistent abdominal pain, vomiting, cessation of materials and gas, systematically look for an obstruction of internal hernia by incarceration in a myomectomy cubicle. Exploratory laparotomy makes it possible to find the etiology and treat it.