A Case of Strangulated Ileus Associated with an Adult Transmesenteric Internal Hernia

Abstract

We report a case of strangulated ileus associated with an adult transmesenteric internal hernia. The patient was a 20-year-old man who presented with an upper abdominal pain and no history of surgery. The following day, the abdominal pain worsened, and the patient sought treatment at our hospital. Abdominal findings included tenderness in the right lower quadrant and severe spontaneous pain over the entire abdomen. A computed tomography examination showed the presence of ascites, a lack of enhancement in a portion of the small bowel, and an ileocecal artery with a course that included a sharp, right turn. We suspected a strangulated bowel obstruction and performed an emergency diagnostic laparoscopy, which revealed a necrotic gastrointestinal tract. The ileum had herniated through a 3-cm ileal mesenteric defect located 5 cm from the ileocecal junction. A gangrenous section of the ileum that was 45 cm in length was resected and was found to contain a mesenteric defect. Although only a few reports of transmesenteric hernia have been made in adults and such cases are difficult to diagnose preoperatively, a differential diagnosis for strangulated ileus should be considered when the patient does not have a history of surgery. Prompt surgery, including a laparoscopy, is important and could be useful for the diagnosis and treatment of transmesenteric internal hernia.