Small Bowel Strangulation Secondary to Strangulated Mesenteric Hiatus Hernia in an Elderly Patient

Abstract

A 74-year-old female was admitted for sudden abdominal pain and vomiting with a diagnosis of acute abdomen. The physical examination revealed tenderness over the entire abdomen with a slight peritoneal irritation sign. An abdominal X-ray image showed widespread dilatation of the small intestine with gas. Enhanced computed tomography revealed massive ascites and decreased enhancement in a long segment of the small intestine. Emergency operation was performed with a suspected diagnosis of small bowel strangulation and obstruction. The laparotomy revealed a strangulated and gangrenous loop of the ileum and cecum. A 160-cm length of the ileocolic segment was proved to be incarcerated into a small 18×20cm mesenteric defect, which was located in the mesentery 180cm from the Treitz ligament. Small bowel strangulation due to mesenteric hiatus hernia was diagnosed and a partial resection of the gangrenous intestine was performed. Mesenteric hiatus hernia is a rare condition, in particular in elderly. Only a few cases in elderly patients have been reported so far. Surgical intervention should be performed immediately when this condition is suspected.