Congenital transmesosigmoid hernia: a rare case of pediatric small-bowel obstruction

Ileocaecal Volvulus With an Intestinal Rotational Abnormality and Internal Hernia in a Paediatric Patient: A Case Report

Background: Caecal volvulus in the paediatric population is uncommon, yet at worst this condition is a life-threatening surgical emergency. In children, caecal volvulus can be associated with a variety of predisposing factors such as chronic constipation, intestinal malrotation, or neurological disease. Case Representation: We present a rare case of caecal volvulus, internal hernia, and an intestinal rotational abnormality in a previously healthy 8-year-old boy. The patient presented with a history of abdominal pain and vomiting for 3 days and was admitted to the hospital in a severe septic shock. After the initial stabilisation with fluids and vasopressors, an emergency laparotomy was performed. A necrotic caecum volvulus, a transmesocolic hernia, and an abnormal rotation of the small intestine were diagnosed. The necrotic bowel segment was resected in a right-sided hemicolectomy, after which a resection distal to medial colic artery was cut-off to achieve normal anatomy. The patient was discharged on the 12th postoperative day in good health and has since returned to normal active life without any health issues within the follow-up of 5 months. Conclusions: Caecal volvulus and internal hernia can lead to a life-threatening condition requiring immediate surgical treatment. Rare causes of abdominal pain in children should be kept in mind when severe symptoms are present.

Congenital sigmoid mesocolic defect as a cause of neonatal intestinal obstruction

Internal herniation through congenital sigmoid mesocolic defect as a cause of neonatal intestinal obstruction is rarely reported. Clinical judgement combined with judicious use of investigations and prompt exploration is essential to provide immediate relief of the obstruction and salvage the herniated loop of bowel, which otherwise might lead to morbidity and even death. We present a neonate with internal herniation of the ileum through a congenital mesocolic defect which was diagnosed by a prompt abdominal exploration in view of persistent clinical signs of intestinal obstruction. The relevant literature is also discussed highlighting the rarity of neonatal presentation of sigmoid mesocolic defect.

Strangulated transmesosigmoid hernia as a late complication of a fall from a height: A case report

INTRODUCTION

A transmesosigmoid hernia is defined as small bowel herniation through a complete defect involving both layers of the sigmoid mesentery. Blunt trauma injury to the sigmoid mesocolon has been reported only rarely. We herein report a case of a strangulated transmesosigmoid hernia associated with a history of a fall from a height.

PRESENTATION OF CASE

A 43-year-old woman presented to our hospital for evaluation of vomiting. She had no history of abdominal surgery but had sustained a complete spinal cord injury and pelvic fracture secondary to a fall from a height 25 years earlier. A computed tomography scan of her abdomen and pelvis demonstrated a closed loop of small bowel in the pelvis, with a zone of transition in the left lower abdomen. Although the cause of the obstruction was difficult to establish, ischemia was strongly suspected; therefore, the decision was made to perform emergency exploratory laparoscopy. During laparoscopy, a loop of ileum was observed to have herniated through a full-thickness defect in the sigmoid mesocolon, consistent with a transmesosigmoid hernia. The herniated loop was strangulated but not gangrenous and was successfully reduced using laparoscopic graspers. The incarcerated small bowel appeared viable and was therefore not resected. The defect was closed with a running suture. The patient had an uneventful postoperative course with no recurrence.

DISCUSSION AND CONCLUSION

Abdominal blunt trauma can cause sigmoid mesenteric rupture resulting in a transmesosigmoid hernia. In the management of transmesosigmoid hernias, laparoscopic herniorrhaphy has the advantage of facilitating simultaneous diagnosis and surgical intervention.

Transmesosigmoid hernia: Case report and review of literature

Transmesosigmoid hernia has previously been considered as a rare condition. The clinical symptoms can be nonspecific. Here, we report a case of acute intestinal obstruction because of transmesosigmoid hernia. In addition, after a comprehensive review of PubMed and China National Knowledge Infrastructure, we present a review of 22 cases of transmesosigmoid hernia. We summarize several valuable clinical features that help early recognition of transmesosigmoid hernia. As a result of easy strangulation, in patients without a history of surgery or abdominal inflammation who present with symptoms of progressive or persistent small bowel obstruction (SBO), surgeons should consider the possibility of transmesosigmoid hernia. In addition, based on our data, in patients with SBO because of transmesosigmoid hernia, the defect is usually 2-5 cm in diameter. Furthermore, because of the high risk of strangulation with transmesosigmoid hernia, it is mandatory to reassess the condition timely and periodically when patients receive conservative treatment.

Laparoscopic management of small bowel obstruction caused by a Sigmoid Mesocolic hernia

Internal hernias involve protrusion of viscera through the peritoneum or mesentery into a compartment in the abdominal cavity. Hernias occurring through the meso-sigmoid are rare and the most common presentation of this entity is an acute small intestinal obstruction. Pre-operative diagnosis is often difficult and the diagnosis is usually made at surgery. Traditionally, open surgery is used to manage a meso-sigmoid hernia. We report a patient with meso-sigmoid hernia causing intestinal obstruction managed successfully by the laparoscopic approach.