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

Traumatic transmesenteric hernia leading to ischemic enterocolitis in an adolescent - case report

INTRODUCTION AND IMPORTANCE

Traumatic transmesenteric hernia (TTMH) is an exceptionally rare condition with high morbidity and mortality, particularly in children. It can cause life-threatening complications such as ischemic enterocolitis. Internal hernias, including transmesenteric types, are difficult to diagnose preoperatively and are often discovered during emergency laparotomy.

CASE PRESENTATION

A 13-year-old girl presented with acute abdominal pain, bilious vomiting, and hypovolemic shock. She had sustained blunt abdominal trauma from a fall two weeks earlier. Initial resuscitation and imaging raised concerns for acute intestinal obstruction. Due to clinical deterioration, an emergency exploratory laparotomy was performed, revealing a transmesenteric hernia with 120 cm of ischemic ileum. Bowel resection and a double-barrel ileostomy were performed. Histopathology confirmed ischemic enterocolitis secondary to the hernia. The patient recovered well and later underwent successful ileostomy reversal.

DISCUSSION

Transmesenteric hernias are rare, typically congenital or post-surgical, with traumatic cases being extremely uncommon. Diagnosis is challenging due to a lack of specific clinical findings. Delayed intervention increases the risk of bowel ischemia and mortality.

CONCLUSION

This case highlights the diagnostic difficulty of TTMH and emphasizes the need for a high index of suspicion in trauma patients presenting with acute abdomen. Educating patients with trauma about warning signs & follow up is the recommendation.

Congenital Transmesenteric Hernia With Closed-Loop Small Bowel Obstruction and Intestinal Gangrene in an Adult

Internal hernias (IHs) are defined as the protrusion of the intestine through an aperture in the peritoneal ligament, mesentery, or the omentum, without traversing the fascial planes and leading to encapsulation of the protruded intestine within another compartment of an otherwise intact abdominal cavity. Internal hernias can be acquired or congenital. Congenital internal hernias resulting in small bowel obstruction are extremely rare, even more so in adults, occurring usually due to embryological or developmental defects, often undiagnosed, and requiring a high index of clinical suspicion. We report a rare case of a 22-year-old young adult with transmesenteric hernia of distal ileum through a congenital distal ileal mesenteric defect resulting in closed-loop small bowel obstruction and distal ileal gangrene, managed with resection and end-ileostomy, followed by stoma reversal one month later. It requires a high index of suspicion and remains a surgical emergency due to its predilection for intestinal gangrene and small bowel obstruction, with a high mortality rate due to delayed presentation and diagnosis.

Right Paraduodenal Hernia as a Cause of Acute Abdominal Pain in the Emergency Department: A Case Report and Review of the Literature

Paraduodenal hernias (PDHs) represent an unusual cause of acute abdominal pain in the Emergency Department (ED) and are associated with high morbidity attributable to a challenging clinical and radiological diagnosis, as signs and symptoms mimic other frequent causes of acute abdominal pain. We report a right paraduodenal hernia in a 37-year-old female patient who presented to the ED complaining of abdominal pain located in the right lower abdomen and hypogastrium, accompanied by nausea. During diagnostic work up, the abdominal computed tomography scan revealed the presence of small bowel malrotation with concomitant right paraduodenal hernia. These findings were confirmed intraoperatively. We performed a brief literature review about the clinical manifestations and treatment options of right paraduodenal hernias, which retrieved only 30 articles related to this condition. Prompt diagnosis, radiological or intraoperative, of paraduodenal hernias is crucial because nearly 50% will progress to small bowel obstruction. Therefore, it is essential for every clinician to account for them in the differential diagnosis of acute abdominal pain in the ED.

A Unique Case of Small Bowel Internal Hernia and Volvulus Caused by a Hamartoma

This study depicts the case of a young female presenting with intestinal obstruction. Surgery uncovered a small bowel hamartoma that has caused a transmesenteric internal hernia and volvulus. As far as we know, this is unheard of before, as all three mentioned entities are very rare. The study also covers a literature review of cases of internal hernia with volvulus and stresses over the need for urgent diagnosis and management.

Post-trauma transmesocolic hernia: a case report

The prevalence of transmesocolic hernias, a subtype of internal hernias (IHs), is generally low. Its clinical consequences, including strangulation, ischemia and even death, however, necessitate awareness. IHs are classified as congenital or acquired as resulting from surgery, trauma or intraperitoneal inflammation. This is a case of a 37-year-old male victim of a motor vehicle collision 1 month prior to the index admission. The trauma-related injuries were managed conservatively and then discharged home. The patient was re-admitted with a 2-day history of epigastric pain, vomiting and abdominal distension. A diagnosis of small bowel obstruction due to a transmesocolic hernia was made on CT and emergency laparotomy performed. The post-operative course was unremarkable. It is vital to consider transmesocolic hernias in trauma patients presenting with a picture of bowel obstruction even in the absence of prior surgery.

[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.

Incarcerated congenital transmesenteric hernia in an adult: a case report

Transmesenteric hernia is a rare cause of bowel obstruction and strangulation. It can be due to iatrogenic injury, trauma, inflammatory and less likely congenital. We present a case of true congenital transmesenteric hernia in a 26-year-old male with no previous surgical history or trauma. The patient presented acutely with no prior symptoms. Investigations provided limited information towards the diagnosis of the hernia, but suggestive of mid-gut volvulus. Emergency laparotomy was performed to find >75% of small bowel herniating through a proximal jejunal mesenteric defect leading to incarceration and early strangulation. No resection was required and patient recovered well. This case presents yet another rare pathology and highlights the importance of keeping a low threshold for operative intervention in uncertain cases.