A Pelvic Hernia Through Two Defects in the Pouch of Douglas in a Patient With Peritoneal Xanogranuloma: A Report of a Very Rare Case.

Pelvic internal hernias, including pouch of Douglas hernias, are a very rare cause of small bowel obstruction. They pose a challenge in diagnosis due to their rarity and lack of specific radiological features. The definitive diagnosis is usually reached intraoperatively. The treatment consists of reduction with or without resection of the herniated bowel and primary repair of the defect. Mesh placement has been reported but is still arguable, as no musculofacial defect is involved. Here, we present a case of a 28-year-old female patient, a nulliparous with multiple medical conditions including familial Mediterranean fever (FMF) and an extremely rare tumor, peritoneal xanthogranuloma. She had a history of laparoscopic left ovarian cystectomy, and complained of abdominal pain and distention for three days prior to admission. Her symptoms were associated with constipation and recurrent vomiting and she was admitted as a suspected case of small bowel obstruction. CT scan suggested the possible diagnosis of a pelvic hernia, yet the definitive diagnosis was reached intraoperatively after noticing the presence of two defects on the left side of the pouch of Douglas. A primary repair of the defects was performed after reduction of the viable herniated bowel. The patient was discharged on the third postoperative day with uneventful course of recovery.