Transmesenteric hernia with two mesenteric defects in an adult

Abstract

Transmesenteric hernia is a rare cause of small bowel strangulation in adults and, to our knowledge, no one has reported the existence of two mesenteric defects in an adult. Our patient was a 73-year-old Japanese woman who presented to our emergency department complaining of abdominal pain and nausea. Computed tomography with contrast enhancement revealed a closed loop obstruction in the pelvis, suggesting small bowel strangulation due to an internal hernia. The emergency exploratory laparotomy indicated a small bowel strangulation caused by a transmesenteric hernia. With the examination across whole parts of the mesentery, we identified another small defect. Both defects were closed by suture intraoperatively, and the patient’s postoperative course was satisfactory. Searching for whole parts of the mesentery after the reduction of a hernia can help prevent the recurrence of internal hernias.

Internal hernia through dual defects: defects in transverse mesocolon and lesser omentum a rare presentation: case report

“…10,12,13 Transmesenteric hernias can be through small bowel mesentery which is more common in children or through the transverse colon mesentery. 12,14 In the index case, the small bowel was herniated through a defect in the transverse colon without the mesenteric sac which was rare compared to herniation through small bowel mesentery. 15 A high index of clinical suspicion is required for internal hernias when there are no signs of inguinal hernia or a history of previous abdominal surgeries.…”

Wael's surgical treatment of intestinal gangrene due to congenital internal hernia: A case report and review of literature

“…The pathogenesis is uncertain. Treves in 1885, emphasized the weakest area in terminal ileum mesentery circumscribed by the ileocolic artery and its last ileal branch 7,8 . Another study found prenatal intestinal ischemia leads to thinning of the mesenteric leaves associated with bowel atresia in 5.5% of cases 7 .…”

Development of transomental hernia shortly after laparoscopic colonic surgery: a case report

“…Korn et al [13] reported complete omental resection in a patient with Swiss cheese omentum containing multiple defects of varying size. In contrast, Cao et al [14] reported the closure of multiple mesenteric defects to preserve the omentum and thus prevent adhesional bowel obstruction.…”