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Zhang X, Ping H, Zhang J, Li K, Li D, Chen K, Duan S, Huang M, Huang H, Li J, Jiang X. Intestinal obstruction caused by mesodiverticular band in children: a cohort study. Pediatr Surg Int 2023; 39:163. [PMID: 36995450 DOI: 10.1007/s00383-023-05443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To explore clinical characteristics, pathogenesis, diagnosis and treatment of intestinal obstruction due to mesodiverticular band (MDB) in children in a single center in China. METHODS The clinical data of 20 children with acute intestinal obstruction due to MDB between 1998 and 2020 were retrospectively analyzed. RESULTS The male-to-female ratio was 14:6 in 20 cases. Except one case of 7-month pregnant stillbirth, the cases were aged from 7 days to 14 years, at the median age of 4.31 years. The common symptoms were vomiting, abdominal pain and/or abdominal distension. About 40% (8/20) of patients had both MDB and Meckel's Diverticulum (MD), while 60% (12/20) of patients had MDB only. Only one case died because of total colonic aganglionosis, while other children recovered after surgery treatment. MDB led to the strangulation of necrotic bowel in six cases, intestinal perforation in one case, and intestinal rupture in one case. Pathologic examination showed thick-walled arteries and or thick venous vascular structures in the cord. All cases had no complications during 1-year follow-up. CONCLUSION MDB results from the remnant of vitelline vessel, and often causes acute intestinal obstruction without special clinical symptoms. Unexplained abdominal pain and distension without surgery history should be paid attention, especially for strangulated intestinal obstruction. Timely surgical exploration is beneficial to avoid intestinal necrosis or even sudden death, and the pathological examination is important for the diagnosis.
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Affiliation(s)
- Xuan Zhang
- Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China.
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
| | - Hongyan Ping
- Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China
| | - Jiuhong Zhang
- Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China
| | - Ke Li
- Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Danli Li
- Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China
| | - Kaihong Chen
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Shouxing Duan
- Department of Pediatric Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, Guangdong, China
| | - Meirong Huang
- Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China
| | - Haihua Huang
- Department of Pathology Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Jianhong Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Xuewu Jiang
- Department of Pediatric Surgery, Pingshan District Maternal & Child Healthcare Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China.
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
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Turek B, Stefanik E, Kozłowska N, Drewnowska-Szczepakowska O, Górski K, Mickiewicz J. Malformation of a Mesocolon as a Cause of Colic in an Arabian Foal. Vet Sci 2021; 8:vetsci8090193. [PMID: 34564587 PMCID: PMC8472953 DOI: 10.3390/vetsci8090193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022] Open
Abstract
This paper describes a case of partial lack of the mesocolon in a 7-month-old colt. The foal was referred to the hospital with clinical signs of severe abdominal distension of a few hours duration. Because analgesics did not relieve pain, the foal remained uncomfortable, and distension of the abdomen increased; an exploratory laparotomy was performed under general anaesthesia in dorsal recumbency. The final diagnosis was confirmed intraoperatively. During exploration of the abdominal cavity, other problems like right dorsal displacement and torsion of the colon were recognized. Correction of all problems was completed, and the mesentery was sutured. Recovery from anaesthesia was uneventful. The foal was recovering well a few months after surgery, and the owner did not complain about the results of the treatment.
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Zheng XX, Wang KP, Xiang CM, Jin C, Zhu PF, Jiang T, Li SH, Lin YZ. Intestinal gangrene secondary to congenital transmesenteric hernia in a child misdiagnosed with gastrointestinal bleeding: A case report. World J Clin Cases 2021; 9:5294-5301. [PMID: 34307581 PMCID: PMC8283599 DOI: 10.12998/wjcc.v9.i19.5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia, and no specific clinical symptoms can be observed preoperatively. Therefore, this condition is not widely known among clinicians, and it is easily misdiagnosed, resulting in disastrous effects.
CASE SUMMARY This report presents the case of a 13-year-old boy with a chief complaint of abdominal pain and vomiting and a history of duodenal ulcer. The patient was misdiagnosed with gastrointestinal bleeding and treated conservatively at first. Then, the patient’s symptoms were aggravated and he presented in a shock-like state. Computed tomography revealed a suspected internal hernia, extensive small intestinal obstruction, and massive effusion in the abdominal and pelvic cavity. Intraoperative exploration found a small mesenteric defect approximately 3.5 cm in diameter near the ileocecal valve, and there was about 1.8 m of herniated small intestine that was treated by resection and anastomosis. The patient recovered well and was followed for more than 5 years without developing short bowel syndrome.
CONCLUSION In this report, we review the pathogenesis, presentation, diagnosis, and treatment of congenital transmesenteric hernia in children.
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Affiliation(s)
- Xi-Xi Zheng
- Department of Pediatric Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Kun-Peng Wang
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Chao-Mei Xiang
- Department of Pediatric Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Peng-Fei Zhu
- Department of Pediatric Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Teng Jiang
- Department of Pediatric Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Shi-Hui Li
- Department of Pediatric Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Yong-Zhi Lin
- Department of Pediatric Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
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Willems E, Willaert B, Van Slycke S. Transmesenteric hernia: a rare case of acute abdominal pain in children: a case report and review of the literature. Acta Chir Belg 2018; 118:388-391. [PMID: 29115904 DOI: 10.1080/00015458.2017.1399662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this report, we discuss the case of an 11-year old girl presenting with acute abdominal pain caused by gangrene of a large part of the small bowel. During urgent surgical exploration, the cause of gangrene appeared to be herniation of the small bowel through a congenital defect in the mesentery with subsequent strangulation. A resection was performed leaving the patient with only 130 cm of small bowel remaining. Transmesenteric hernia is a rare type of internal herniation consisting of a small congenital defect in the small bowel mesentery through which the intestine can herniate and subsequently become strangulated. We present a case of transmesenteric hernia with disastrous effects and review the literature regarding this rare type of hernia.
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Affiliation(s)
- Edward Willems
- Department of General and Abdominal Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Bart Willaert
- Department of General and Abdominal Surgery, OLV Hospital Aalst, Aalst, Belgium
| | - Sam Van Slycke
- Department of General and Abdominal Surgery, OLV Hospital Aalst, Aalst, Belgium
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5
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Sérénon V, Duclos J, Sielezneff I. Mesenteric hernia: A tricky diagnosis of bowel obstruction in adults. J Visc Surg 2018; 155:337-338. [DOI: 10.1016/j.jviscsurg.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lethal small intestinal herniation through a congenital mesenteric defect. Forensic Sci Med Pathol 2018; 15:140-142. [PMID: 30069660 DOI: 10.1007/s12024-018-0009-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
A three-year-old boy with mild symptoms of an upper respiratory tract infection and recent onset vomiting collapsed at home. Resuscitative attempts in hospital were eventually unsuccessful. At autopsy an obstruction of the small intestine, with ischemia, was identified. It had been caused by strangulation of the small intestine through a congenital mesenteric defect. Moderate mesenteric lymphadenopathy, with enlarged lymph nodes in the region of the herniated small intestine, were associated with positive testing for human metapneumovirus and enterovirus. Transmesenteric hernias are a very rare form of internal herniation that have the highest risk of strangulation. Unfortunately in children the presentation may be relatively nonspecific with a precipitate decline towards the end. In the reported case it is possible that mesenteric lymphadenopathy may have contributed to intestinal entrapment by preventing spontaneous reduction.
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Rattan KN, Singh J, Dalal P. Congenital transmesenteric strangulated hernia in a neonate: a case report. Trop Doct 2017; 48:51-52. [PMID: 28403696 DOI: 10.1177/0049475517701787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kamal Nain Rattan
- 1 Senior Professor and Head, Department of Paediatric Surgery, PGIMS, Rohtak, Haryana 124001, India
| | - Jasbir Singh
- 2 Senior Resident, Department of Paediatrics, PGIMS, Rohatk, Haryana 124001, India
| | - Poonam Dalal
- 3 Associate Professor, Department of Paediatrics, PGIMS, Rohtak, Haryana 124001, India
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9
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Hirata K, Kawahara H, Shiono N, Nishihara M, Kubota A, Nakayama M, Kitajima H. Mesenteric hernia causing bowel obstruction in very low-birthweight infants. Pediatr Int 2015; 57:161-3. [PMID: 25711255 DOI: 10.1111/ped.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 04/08/2014] [Accepted: 04/30/2014] [Indexed: 11/28/2022]
Abstract
Internal hernia through a mesenteric defect, called mesenteric hernia, is an uncommon cause of acute intestinal obstruction in newborns. Strangulated mesenteric hernia results in intestinal necrosis or perforation and progressive deterioration with fatal outcome, especially when it occurs in low-birthweight infants. We report two very low-birthweight (VLBW) infants, who presented with acute intestinal obstruction related to mesenteric defect. The initial diagnosis was meconium obstruction in those cases, which is a common cause of bowel obstruction occurring in VLBW infants. Correct diagnosis of mesenteric hernia was difficult in these cases because of rapid deterioration and non-specific radiological findings. Awareness of the possibility of rare mesenteric hernia causing acute intestinal obstruction and surgical intervention in an appropriate timeframe are important for rescuing VLBW infants with such organic abnormalities.
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Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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Hu MH, Huang GS, Chen JC, Wu CT. Mesenteric defect with internal herniation in the pediatric emergency department: an unusual presentation of acute abdomen. Pediatr Neonatol 2014; 55:145-9. [PMID: 23597540 DOI: 10.1016/j.pedneo.2012.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 06/06/2012] [Accepted: 11/20/2012] [Indexed: 11/30/2022] Open
Abstract
Internal herniation is a rare cause of intestinal obstruction, especially in the emergency department. We report a child with acute abdomen resulting from transmesenteric internal herniation of the small bowel. Radiographic findings revealed gaseous distension of the bowel loops in the upper abdominal area with a paucity of gas in the lower abdomen. Operative finding showed gangrenous small bowel due to mesenteric defect with an internal herniation. The gangrenous bowel was resected and the patient was discharged with an uneventful outcome. We emphasize that early recognition of internal herniation warrants further evaluation and appropriate management.
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Affiliation(s)
- Mei-Hua Hu
- Department of Pediatric, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Keelung, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Department of General Pediatric, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Go-Shine Huang
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Nei-Hu, Taipei, Taiwan
| | - Jeng-Chang Chen
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Teng Wu
- Department of General Pediatric, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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11
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Alaker M, Mathias J. Internal herniation through a defect in the transverse mesocolon. BMJ Case Rep 2014; 2014:bcr-2013-202753. [PMID: 24567183 DOI: 10.1136/bcr-2013-202753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Internal hernias are rare, constituting 5.8% of all intestinal obstruction cases. Congenital transverse mesocolon hernias in adults are specifically rare. We hereby present a case of an adult female presenting with acute intestinal obstruction. Her CT scan showed classic signs of internal herniations: 'Whirlpool sign', crowding of bowel loops in the upper compartment and the absence of caecum from the Right Iliac Fossa. At operation, she was found to have a congenital defect in the transverse mesocolon, through which have herniated the terminal ileum, caecum and the proximal half of the ascending colon. They have furthermore rotated 360° about the axis of the pedicle forming a volvulus. The bowel was viable. The herniated bowel was derotated, and reduced through the defect, the defect was closed with polydioxanone sutures, and the caecum and ascending colon was fixed to the lateral abdominal wall.
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Affiliation(s)
- Medhat Alaker
- Department of General Surgery, Withybush Hospital, Haverfordwest, Pembrokeshire, UK
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Abstract
Internal hernia is one of the rare causes of small bowel obstruction. A congenital mesenteric defect is very rare, but can potentially cause internal hernia with consequent incarceration or strangulation of the small intestine. An 18-year-old woman was brought to our emergency department with sudden onset lower abdominal pain. She had no remarkable past medical history and took no medications. An emergency laparotomy was performed. On exploring the abdominal cavity, the mesenteric defect was detected in the jejunal region, 3 cm in size. Loops of small intestine had gone through the defect three times in a complex manner and strangulated. Gangrenous intestine was resected and a primary anastomosis was performed. An adult congenital mesenteric defect is rare; however, it should be considered as one of the differential diagnoses in a relatively young patient with bowel obstruction without external hernia, previous abdominal surgery or trauma.
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Affiliation(s)
- Hideki Katagiri
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center (Noguchi Hideyo Memorial International Hospital), Chiba, Japan
| | - Kenji Okumura
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center (Noguchi Hideyo Memorial International Hospital), Chiba, Japan
| | - Junji Machi
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center (Noguchi Hideyo Memorial International Hospital), Chiba, Japan Department of Surgery, University of Hawaii, Honolulu, Hawaii
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Llore N, Tomita S. Apple peel deformity of the small bowel without atresia in a congenital mesenteric defect. J Pediatr Surg 2013; 48:e9-11. [PMID: 23331843 DOI: 10.1016/j.jpedsurg.2012.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 11/26/2022]
Abstract
Congenital mesenteric defects are rare causes of bowel obstruction. Even rarer are mesenteric defects with an apple peel type of deformity, probably described definitively only once previously. We present a case of a 3 year old boy who presented with a septic-like picture of severe metabolic acidosis and lethargy from a bowel obstruction with bowel ischemia. At laparotomy he was found to have bowel infarction due to herniation through a congenital mesenteric defect with an apple peel type of deformity of the bowel without bowel atresia.
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Affiliation(s)
- Nathaly Llore
- Division of Pediatric Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY 10016, USA
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Tassinari D, Santoro S, Bernardi F, Lima M. A mesenteric hernia complicated with a triple necrotic volvulus. BMJ Case Rep 2012; 2012:bcr-2012-006448. [PMID: 23008368 DOI: 10.1136/bcr-2012-006448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 6-year-old girl was admitted to the paediatric emergency department with colicky abdominal pain. She had a significant medical history, with four previous admissions due to recurrent abdominal pain in the past year. On examination the abdomen was soft, there was no rebound tenderness and Rovsing's sign was negative. Her blood tests revealed a raised white cells count, although her C reactive protein was within the normal range. Abdominal x-ray revealed small bowel obstruction. During her assessment the patient rapidly deteriorated and seemed to go into shock. Her clinical state in addition to the radiological findings meant that she was taken to theatre for surgical exploration. This showed a triple volvulus with necrotic bowel loops that had herniated through a mesenteric defect. The necrotic bowel was subsequently resected.
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Affiliation(s)
- Davide Tassinari
- Paediatric Emergency Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Sato T, Abe S, Tsuboi K, Iwata M, Tamura A, Tsuchihashi H, Nishio H, Suzuki K. Sudden death of a child because of an intestinal obstruction caused by a large congenital mesenteric defect. Leg Med (Tokyo) 2012; 14:157-9. [DOI: 10.1016/j.legalmed.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 01/18/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
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Kakimoto Y, Abiru H, Kotani H, Ozeki M, Tsuruyama T, Tamaki K. Transmesenteric hernia due to double-loop formation in the small intestine: a fatal case involving a toddler. Forensic Sci Int 2012; 214:e39-42. [PMID: 21856100 DOI: 10.1016/j.forsciint.2011.07.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/13/2011] [Accepted: 07/25/2011] [Indexed: 12/27/2022]
Abstract
We report a unique case of transmesenteric hernia resulting in death, which went undiagnosed during a recent hospital visit. The victim was a 2.5-year-old girl who - with the exception of chronic constipation - had no medical history. One night she complained of abdominal pains and was taken to a pediatric hospital where doctors performed an abdominal X-ray and echography. No significant findings suggesting bowel obstruction (e.g. air-fluid levels or dilation of the bowel) were obtained on examinations and bloody feces were not observed in this particular episode. As her abdominal pain gradually attenuated, the doctor allowed her to return home. A few hours later, she lost consciousness and expired despite resuscitation efforts attempted at an emergency hospital. A subsequent autopsy revealed that the small bowel had herniated through a defect in the mesentery resulting in two consecutive and inversely forming loops, in which each loop protruded on either side of the mesentery. This rare morphological anatomy seems to have progressed in a two-step process. The girl's mild abdominal pain was likely induced by herniation and formation of the first intestinal loop, followed by severe shock occurring when the subsequent intestinal segment invaginated into the same defect forming the second loop on the opposite side of the mesentery. This case illustrates the difficulty of diagnosing transmesenteric hernia due to the presentation of unspecific symptoms; especially in infants and toddlers. Furthermore, this report demonstrates the value of a complete autopsy in cases of sudden and unexpected deaths involving children.
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Affiliation(s)
- Yu Kakimoto
- Department of Forensic Medicine and Molecular Pathology, Kyoto University, Graduate School of Medicine, Yoshida-Konoe Sakyoku, Kyoto, Japan.
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Malit M, Burjonrappa S. Congenital mesenteric defect: Description of a rare cause of distal intestinal obstruction in a neonate. Int J Surg Case Rep 2011; 3:121-3. [PMID: 22288064 DOI: 10.1016/j.ijscr.2011.12.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/13/2011] [Accepted: 12/18/2011] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Internal hernias are a rare cause of bowel obstruction in the neonate and present with bilious vomiting. Newborns may be at risk of loss of significant length of bowel if this rare condition is not considered in the differential diagnosis of bilious emesis. PRESENTATION OF CASE We report a case of a twin with an internal hernia through a defect in the ileal mesentery who presented with neonatal bowel obstruction. The patient had a microcolon on the contrast enema suggesting that the likely etiology was an intra-uterine event most likely a vascular accident that prevented satisfactory meconium passage into the colon. DISCUSSION An internal hernia is rarely considered in the differential diagnosis of distal bowel obstruction in a neonate with a microcolon. Congenital trans-mesenteric hernias constitute only 5-10% of internal hernias. True diagnosis of trans-mesenteric hernias is difficult due to lack of specific radiology or laboratory findings to confirm the suspicion. CONCLUSION When clinical and radiological findings are not classical, rare possibilities such as an internal hernia must be considered in the differential diagnosis, to avoid catastrophic bowel loss.
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Affiliation(s)
- Michele Malit
- Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, United States
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18
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Internal hernias in children: spectrum of clinical and imaging findings. Pediatr Radiol 2011; 41:1559-68. [PMID: 21735180 DOI: 10.1007/s00247-011-2158-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 04/12/2011] [Accepted: 05/03/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND Internal hernias are uncommon in children and their clinical and imaging findings have not been widely addressed. OBJECTIVE To determine the spectrum of clinical and imaging findings of internal hernia (IH) in children and to highlight diagnostic features. MATERIALS AND METHODS Review of clinical, imaging and surgical findings in 12 children with surgically proven IH. RESULTS IH found in seven girls and five boys. Five of the children were neonates and seven were between ages 8-17 years. All neonates presented acutely and had transmesenteric internal hernias (TMIH) (four congenital, one acquired). In the older children, five presented with chronic symptoms and two presented with acute symptoms; the former had paraduodenal hernias (all congenital) and the latter had a congenital pericecal and an acquired TMIH. Only 2/5 neonatal TMIH could be appreciated on GI contrast examination. All five paraduodenal hernias were easily diagnosed on UGI series. CT, in two older children, depicted a paraduodenal hernia and the acquired TMIH. In 7/10 (70%) congenital IH, there was associated malrotation (in all four right paraduodenal hernias). CONCLUSION There is a wide spectrum of clinical and imaging findings of IH in children. TMIH were difficult to appreciate on GI contrast examinations, but paraduodenal hernias were easy to appreciate. One must have a high index of suspicion for right paraduodenal hernia if UGI series shows duodenum and proximal small bowel to the right of the spine.
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Herbst J, Langlois NEI. Congenital mesenteric abnormality causing death in an infant with a concurrent diaphragmatic hernia. Forensic Sci Med Pathol 2010; 6:54-7. [PMID: 20084555 DOI: 10.1007/s12024-009-9135-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2009] [Indexed: 11/28/2022]
Abstract
The principle causes of infant death are natural causes [including the Sudden Infant Death Syndrome (SIDS)]. Natural deaths in infants are principally due to infections, cardiovascular anomalies and other metabolic or genetic disorders. Gastrointestinal pathology including anomalies may also cause death in this age group. This case describes a 6 month old boy who had undergone repair of a diaphragmatic hernia when aged 2 days, but who subsequently died as a result of a mesenteric abnormality with torsion of the gut and a large fibrous walled bowel containing hernial sac in the left pleural cavity.
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Affiliation(s)
- Jonathon Herbst
- Forensic Science South Australia, 21 Divett Place, Adelaide, SA, 5000, Australia.
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20
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Gyedu A, Damah M, Baidoo PK, Yorke J. Congenital transmesenteric defect causing bowel strangulation in an adult. Hernia 2009; 14:643-5. [PMID: 20091075 DOI: 10.1007/s10029-009-0600-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 11/13/2009] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Congenital transmesenteric hernias represent a very small group of internal hernias which are uncommon and are a rare cause of intestinal obstruction. Diagnosis is frequently made at surgery. Reports of congenital transmesenteric hernia in the English literature usually involve the pediatric population; adult cases are rarer. CASE REPORT A 22-year-old man who presented with a day's history of severe abdominal pain but without classic physical examination signs of abdominal obstruction was operated upon on account of increasing abdominal pain and distention associated with shock. Laparotomy revealed a congenital transmesenteric defect through which loops of bowel had herniated and become gangrenous, resulting in resection and end-to-end anastomosis. DISCUSSION Congenital transmesenteric defects causing internal hernias in adults are rare. Preoperative diagnosis of the condition is difficult, in part, because there are no radiographic or laboratory findings to confirm the suspicion. Misdiagnosis resulting in delayed exploration may lead to small bowel necrosis and subsequent mortality. CONCLUSION A congenital internal hernia should be considered in a patient with bowel obstruction without previous abdominal surgery, inflammatory abdominal condition, or trauma. We wish to emphasize that, rather than trying to establish a correct diagnosis, the patient's clinical features should lead to early surgery in order to reduce morbidity and possible mortality.
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Affiliation(s)
- A Gyedu
- Department of Surgery, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana.
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Abstract
Altered mental status can have many causes, some of which are life threatening, especially in children. In addition to the usual central nervous system and metabolic causes, such as meningitis, encephalitis, seizure, electrolyte imbalance, and inborn errors of metabolism, some less common causes of altered mental status, which if not diagnosed and managed rapidly, can have poor consequences. We present a case of a child with a life-threatening unusual cause of altered mental status, a mesenteric hernia with hypovolemic shock. The hernia was reduced successfully at laparotomy. The postoperative course was uneventful.
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Park CY, Kim JC, Choi SJN, Kim SK. A transmesenteric hernia in a child: gangrene of a long segment of small bowel through a large mesenteric defect. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 53:320-3. [PMID: 19458470 DOI: 10.4166/kjg.2009.53.5.320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.
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Affiliation(s)
- Chan Yong Park
- Department of Surgery, Chonnam National University Medical School, Dong-gu, Gwangju, Korea.
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