A Transmesosigmoid Hernia: A Case Report

Abstract

A 53-year-old man developed diarrhea, vomiting, and left-sided abdominal pain. Abdominal plain computed tomography (CT) revealed dilation of the small intestine, accumulation of intestinal contents, and ascites. He was admitted to our hospital with the diagnosis of severe gastroenteritis. On the 6th day post admission, CT suggested strangulated ileus secondary to a transmesosigmoid hernia. Contrast-enhanced CT revealed worsening dilation of the enhanced loops of the small intestine. On the 8th day, we performed an emergency operation under the suspected diagnosis of a transmesosigmoid hernia. Laparotomy revealed an oval defect measuring 3 cm in diameter in the sigmoid colon. Approximately 110 cm of the small intestine was observed to have herniated through the defect from the outside of the sigmoid colon. The herniated intestine was not necrotic, and the oval defect was closed. A few reports have described patients with a transmesosigmoid hernia, which is difficult to diagnose preoperatively. A transmesosigmoid hernia should be considered among the differential diagnoses of strangulated ileus in patients without a history of surgery. Prompt surgery is important.