Congenital mesenteric defect: Description of a rare cause of distal intestinal obstruction in a neonate

Small bowel obstruction caused by transmesenteric hernia in a patient with complex medical history: a case report

This case report presents a rare instance of small bowel obstruction due to a transmesenteric hernia in a 47-year-old male with a complex medical history. The patient presented with acute abdominal pain, constipation, and urinary retention. Diagnostic laparoscopy revealed bowel ischemia, and open laparotomy confirmed a transmesenteric hernia with necrotic small bowel requiring resection. Postoperative recovery was uneventful, and the patient was discharged with follow-up plans. This case underscores the importance of considering internal abdominal hernias in the differential diagnosis of acute abdominal pain.

Congenital Transmesenteric Hernia - A Rare Presentation

Congenital transmesenteric defect is a rare but serious condition which presents a diagnostic challenge as symptoms and investigations are nonspecific. Here, we present a case with fetal ascites and dilated bowel loops who underwent intervention within 6 h of birth. Laparotomy showed volvulus and gangrene of 45 cm of the distal ileum, which was herniating through mesenteric defect. Timely detection and intervention can help in preventing significant morbidity and mortality. Given the downside to delay of surgical intervention and lack of specific tests, open exploration continues to be the only way to establish a definitive diagnosis of a transmesenteric hernia.

Transmesenteric hernia with closed-loop small bowel obstruction: A case report

Background

Transmesenteric hernia is a subtype of internal abdominal hernia (IAH) and a rare cause of small bowel obstruction in adults. Difficulty in reaching a definitive diagnosis due to non-specific clinical and imaging findings often cause life-threatening bowel ischemia.

Case report

We report a case of a 37-year-old female who presented with clinical and imaging features of small bowel obstruction. She underwent an emergency laparotomy where the diagnosis of transmesenteric hernia causing closed-loop obstruction was made. The non-viable portion of the intestine was resected, anastomosis of the ileum along with the closure of the mesenteric defect was performed.

Discussion

IAH is the protrusion of abdominal viscera, most commonly small bowel loops through a peritoneal or mesenteric defect into the abdominal or pelvic cavity. Considered common in children, it is rare in adults and is most common after abdominal surgeries like Roux-en-Y gastric bypass surgery. Clinical features and imaging findings are non-specific causing delay in the diagnosis.

Conclusion

A high index of suspicion is required while assessing the patient with symptoms suggestive of acute bowel obstruction as the preoperative diagnosis of a transmesenteric hernia is challenging.

•

Transmesenteric hernia causing small bowel obstruction in the adult is rare.

•

Diagnosis is often delayed due to non-specific clinical and imaging features.

•

Careful exploration of the whole mesentery after reduction of hernia can prevent recurrences.

More than just gastritis: An unusual presentation of strangulated transmesenteric hernia in a pediatric patient

Internal hernias are a rare occurrence, reported in only 0.2-0.9% of the general population, and predominantly occur in adult patients as postsurgical complications. However, internal hernias can occur in pediatric patients, typically due to herniation of bowel through congenital mesenteric defects, and are associated with high rates of strangulation or volvulus (up to 30-40%) in this population. These can be especially difficult to detect due to nonspecific symptoms and rarity, but carry a steep mortality rate of 45% if treated and virtually 100% if missed. We present a case report that describes a 3 year old patient who presented to the emergency department with less than 12 h of nonbloody, nonbilious emesis and associated abdominal pain with preserved ability to tolerate oral intake. She ultimately went on to have ultrasound and then CT imaging that revealed a high grade bowel obstruction due to an internal hernia from a mesenteric defect for which she required emergent resection of 119 cm of necrotic bowel. Ultimately this case illustrates a fairly benign presentation of a rare etiology of pediatric vomiting and abdominal pain that if left undetected could prove fatal, and is therefore essential for the emergency clinician to consider on the differential for vomiting and nonspecific abdominal pain in the pediatric patient.

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

A high clinical sense of the surgeon is mandatory in unstable deteriorating patients. Usually, a definitive diagnosis through an urgent laparotomy for repair of transmesenteric hernia and resection of gangrenous bowel leads to a successful outcome.

[Occlusion secondary to congenital internal transmesenteric hernia: about 2 cases]

La hernie interne à travers un défect du mésentère ou hernie transmésentérique est une cause rare d'occlusion intestinale aiguë. Son diagnostic est le plus souvent réalisé en per opératoire. La connaissance de ses particularités cliniques permet d'envisager le diagnostic préopératoire. Nous présentons 2 cas d'occlusion intestinale aiguë causée par une hernie transmésentérique congénitale chez 2 adultes. Nous discutons des particularités cliniques de cette forme rare de hernie interne.

Congenital mesenteric hernia in neonates: Still a dilemma

Congenital transmesenteric hernia in neonates is a rare cause of intestinal obstruction with devastating outcomes and still remains a challenge to diagnose pre-operatively. Patients are often managed with emergency surgical exploration and may need bowel resection. We present 2 neonates with small bowel obstruction secondary to strangulated transmesenteric hernia through a congenital defect in the small bowel mesentery, which were managed successfully. We have also reviewed the literature about congenital transmesenteric hernia in neonates.

Mesenteric Defect with Internal Herniation: A Rare Cause of Bowel Obstruction in Newborn

Herniation through a congenital mesenteric defect is a rare cause of intestinal obstruction in the newborn. Early diagnosis and surgical treatment improves the prognosis. We present a case of a full-term infant who presented with respiratory distress at birth. Enteral feeding was not started because abdominal distension and delayed passage of meconium. Bowel obstruction was suspected. Radiological investigation did not provide a clear diagnosis. Surgical exploration revealed transmesenteric congenital hernia. After surgical repair, enteral feeding was tolerated and patient was discharged with an uneventful outcome. Diagnostic difficulties were discussed.

Mesenteric hernia causing bowel obstruction in very low-birthweight infants

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.

Right sided transmesentric hernia: A rare cause of acute abdomen in adults

INTRODUCTION

Transmesenteric mesocolic hernias are a rare cause of acute abdomen in adults with few reported cases in published literature.

PRESENTATION OF CASE

We report a rare case of a 30-year-old male with right-sided transmesenteric hernia of ileum due to a congenital mesocolic defect resulting in acute abdomen, presenting as acute abdomen. The hernia was reduced, small bowel inspected for gangrene and mesenteric hernia repaired, following which the patient made a good recovery and was discharged 5 days later.

DISCUSSION

The insidious onset of transmesenteric herniae and lack of specific radiological or laboratory investigations reaffirms the importance of surgeons maintaining a high index of suspicion for this surgical emergency.

CONCLUSION

Transmesentric hernia though rare can present as a case of acute abdomen in an emergency. The diagnosis is purely by a CT scan and close monitoring of the patient's general condition in cases of non-specific abdominal pain is essential to identify the rare deteriorating patient for early surgical intervention and optimal outcome.

Trans-mesenteric hernia in infants: report of two cases

Internal hernias are rare causes of intestinal obstruction in children. Trans-mesenteric hernia remains the most common form. We report transmesenteric hernia in a neonate and infant presented with intestinal obstruction.

Internal herniation through a defect in the transverse mesocolon

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.

Internal hernia due to mesenteric defect

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.

Transmesenteric hernia: A rare cause of bowel ischaemia in adults

INTRODUCTION

Transmesenteric herniae are a rare cause of bowel ischaemia in adults with few reported cases in published literature.

PRESENTATION OF CASE

We report a rare case of a 26-year-old female with spontaneous transmesenteric hernia of jejunum and proximal ileum due to a congenital mesenteric defect resulting in bowel gangrene, presenting initially with no haemodynamic or biochemical abnormalities. The hernia was reduced, small bowel resected and primary side to side anastomosis performed, following which the patient made a good recovery and was discharged 5 days later.

DISCUSSION

The insidious onset of transmesenteric herniae and lack of specific radiological or laboratory investigations reaffirms the importance of surgeons maintaining a high index of suspicion for this critical surgical emergency.

CONCLUSION

Close monitoring of the patient's general condition in cases of non-specific abdominal pain is essential to identify the rare deteriorating patient for early surgical intervention and optimal outcome.

Apple peel deformity of the small bowel without atresia in a congenital mesenteric defect

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.

A mesenteric hernia complicated with a triple necrotic volvulus

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.