A Strangulated Trans Mesenteric Hernia- An Unusual Case of Acute Abdomen

Abstract

A 21-year-old boy presented with pain in abdomen associated with abdominal distension and vomiting since 2-3 days. On systemic examination, the vital parameters were normal. On per abdominal examination, he had generalised distension and mild tenderness in the umbilical region. The bowel sounds were sluggish. On admission, the patient was kept nil by mouth, nasogastric tube was inserted, and intravenous antibiotics and fluids were administered. All routine biochemical investigations sent were normal. An internal hernia is defined as protrusion of a viscus through a normal or abnormal opening within the boundaries of peritoneal cavity. [1] It is reported that 0.2-0.9% of patients of small bowel obstruction have internal hernia. [2] Internal hernias are a rare cause of intestinal obstruction with paraduodenal hernias being the most common type of congenital internal hernias. [2] Trans mesenteric type of hernias constitute 5% to 8% of cases of internal hernias. [3] Despite congenital origin, an asymptomatic congenital internal hernia can be diagnosed in adulthood. Mesenteric defect can present with intestinal obstruction and cause incarceration or strangulation. [4] Therefore, a high degree of suspicion is required to lead to early surgical intervention in these cases to reduce morbidity and mortality. [5]