Background

The broad ligament is a peritoneal fold that attaches the uterus, fallopian tubes, and ovaries to the pelvis. Disorders of the broad ligament are rare and evaluation of clinical literature reveals largely case reports. In this write-up, the many reported disorders are debated.

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Embryology

The wide ligaments are formed after the fusion of both müllerian ducts. This fusion brings together 2 peritoneal folds that end up being the wide ligament on each side of the fprovided müllerian ducts. The müllerian ducts inevitably canalize and also come to be the uterus, the fallopian tubes, and also the cervix.


Anatomy and physiology

The broad ligament is a double-layered sheet of mesothelial cells. It exoften tends from the sides of the uterus medially to the pelvic sidewalls laterally and also the pelvic floor inferiorly. Superiorly, it engulfs sequentially from anterior to posterior the round ligaments, fallopian tubes, and also utero-ovarian ligaments. Medially, it encloses the uterus, and also laterally, it encloses the ovarian vessels developing the infundibulopelvic ligament, attaching the ovaries to the lateral pelvic sidewall. The 2 layers of the wide ligaments are consistent through each various other at a free edge that surrounds the fallopian tubes.


Between the 2 layers of the broad ligament is extraperitoneal tworry referred to as the parametrium and also consists of connective tconcern, smooth muscles, nerves, and also blood vessels. The mesovarium is a brief peritoneal fold that attaches the anterior border of the ovary to the posterior leaf of the broad ligament. The mesosalpinx is the part of the wide ligament that lies between the utero-ovarian ligament, the odiffer, and the fallopian tube.

Together through the uterus, the broad ligament develops a septum throughout the female pelvis, separating that cavity into 2 compartments—in the anterior part is the bladder and in the posterior component is the rectum. The wide ligament is believed to hold the uterus in its normal position within the pelvis and also maintains the relationship of the fallopian tubes to the ovaries and the uterus, a duty that might be necessary in reproduction. However, the wide ligament plays a minimal duty, if any kind of, in pelvic assistance. The major assistance of the uterus is the pelvic floor.


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Anatomic defects and inner herniation

Anatomic defects of the broad ligament have the right to be either congenital (as an outcome of a developmental defect) or acquired. Several components have actually been attributed to causing these defects, including trauma throughout pregnancy or distribution, pelvic inflammatory illness, endometriosis, and surgical damage. Congenital cystic structures have been explained within the broad ligament as remnants of the mesonephric or müllerian ducts. When these cysts rupture, they have been hypothesized to leave behind a defect in the broad ligament. Spontaneous rupture of these cysts could account for defects in patients who are nulliparous, have never before undertaken a pelvic surgical procedure, or have actually never had pelvic inflammatory condition. Operative, birth, or pregnancy traumas may additionally induce such a defect in the broad ligament by rupturing the cystic embryologic remnants. <1>


Although many typically unilateral, the defect have the right to happen bilaterally. Hunt classified wide ligament defects right into 2 types <2> :


The fenestra type: The defect involves both the anterior leaf and also the posterior leaf of the broad ligament, developing an open up window anteriorly to posteriorly.

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The pouch type: The defect requires only 1 layer, either the anterior leaf or the posterior leaf of the wide ligament.