BROAD LIGAMENT HAEMATOMA FOLLOWING NORMAL VAGINAL DELIVERY
AbstractA 37-year-old, patient presented in emergency with history of normal vaginal delivery followed by development of abdominal distention, vomiting, constipation for last 3 days. She was para 4 and had normal vaginal delivery by traditional birth attendant at peripheral hospital 3 days back. Imaging study revealed a heterogeneous complex mass, ascites, pleural effusion, air fluid levels with dilatation gut loops. Based upon pelvic examination by senior gynaecologist in combination with ultrasound; a clinical diagnosis of broad ligament haematoma was made. However, vomiting and abdominal distention raised suspicion of intestinal obstruction. Due to worsening abdominal distention exploratory laparotomy was carried out. It was pseudo colonic obstruction and caecostomy was done. Timely intervention by multidisciplinary approach saved patient life with minimal morbidity.Keywords: Broad ligament; haematoma; pseudo intestinal obstruction; caecostomy
Saleem N, Ali HS, Irfan A, Afzal B. Broad ligament hematoma following a vaginal delivery in primigravida. Pak J Med Sci 2009;25(4):683–5.
Kovo M, Eshed I, Malinger G. Broad ligament hematoma following a normal vaginal delivery. Gynecol Surg 2006;3(2):138–40.
Edmonds K, Editor. Dewhurst’s Textbook of Obstetrics & Gynecology for postgraduates. 6th ed. Oxford Wiley-Blackwell; 1999.
Addo V, Kokroe FA, Reindorf RL. Broad ligament hematoma following a Snake Bite. Ghana Med J 2009;43(4):181–2.
Murali R, Hosni MM, Navaneetham N. A Rare Case of Broad Ligament Haematoma 24 Hours after Normal Vaginal Delivery. J Clin Case Rep 2014;4(7):391.
Jain KA, Olcott EW. Magnetic resonance imaging of postpartum pelvic hematomas: early experience in diagnosis and treatment planning. Magn Reson Imaging 1999;17(7):973–7.
Maxwell C, Gawler D, Green J. An unusual case of acute postpartum broad ligament haematoma. Aust N Z J Obstet Gynecol 1997;37(2):239–41.
Muthulakshmi B, Francis I, Magos A, Roy M, Watkinson A. Broad ligament haematoma after a normal delivery. J Obstet Gynecol 2003;23(6):669–70.
Choi JS, Lim JS, Kim H, Choi JY, Kim MJ, Kim NK, et al. Colonic pseudoobstruction: CT findings. AJR Am J Roentgenol 2008;190(6):1521–6.
Coulie B, Camilleri M. Intestinal pseudo-obstruction. Annu Rev Med 1999;50:37–55.
Do YS, Myung SJ, Kwak SY, Cho S, Lee E, Song MJ, et al. Molecular and cellular characteristics of the colonic pseudo-obstruction in patients with intractable constipation. J Neurogastroenterol Motil 2015;21(4):560–70.
Alwan MH, van Rij AM. Acute colonic pseudo-obstruction. Aust N Z J Surg 1998;68(2):129–32.
Dorudi S, Berry AR, Kettlewell MG. Acute colonic pseudo-obstruction. Br J Surg 1992;79(2):99–103.
Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc 1996;44(2):144–50.
Benacci JC, Wolff BG. Cecostomy. Therapeutic indications and results. 1995;38(5):530–4.