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J Minim Access Surg. 2019 Nov 29. doi: 10.4103/jmas.JMAS_79_19. [Epub ahead of print]

Pouch of Douglas internal hernia successfully treated laparoscopically.

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Department of Minimal Invasive Surgery, Citizens Specialty Hospital, Hyderabad, Telangana, India.


A rare case of internal herniation of a peritoneal defect in the pouch of Douglas is being reported. It presented as a case of intestinal obstruction, which after investigation, on laparoscopic exploration was found to be a case of internal hernia getting obstructed in the pouch of Douglas. It was successfully treated by marsupialisation of the defect laparoscopically. A 33-year-old female presented with pain abdomen and vomiting. On investigations, she was found to be having a small intestinal obstruction. Conservative trial failed and then diagnostic laparoscopy was done, which revealed a peritoneal defect in the pouch of Douglas with the incarcerated distal ileal loop. Contents were reduced, and laparoscopic marsupialisation of the peritoneal defect was done. A rare case of defect in peritoneum with no defect in muscular layer in the pouch of douglas. Internal hernia is being reported and successfully treated laparoscopically by marsupialisation for the first time.


Diagnostic laparoscopy; internal hernia; intestinal obstruction; pouch of Douglas

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