A Case of Strangulation Ileus Due to Intramesosigmoid Hernia

Abstract

A 39-year-old man visited his neighborhood hospital with a history of abdominal pain, vomiting, and chills; when his symptoms worsened 6 hours after onset, he was referred to our hospital. Abdominal contrast-enhanced CT revealed distension of the small intestine with a closed loop obstruction posterior to the sigmoid mesocolon. The suspected diagnosis was strangulated ileus secondary to an internal hernia, and emergency laparotomy was performed. Intraoperatively, we observed strangulation of an approximately 6-cm segment of the small intestine that had herniated through a mesenteric defect measuring 1.5 cm in diameter in the right leaf of the sigmoid mesocolon. We diagnosed the patient as having strangulated ileus secondary to an intramesosigmoid hernia. As the incarcerated portion of the small intestine was viable, we did not perform intestinal resection, and completed the surgery by closing the defect in the sigmoid mesocolon. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day. Intramesosigmoid hernia is relatively rare. We discuss the treatment strategy for internal hernias through a defect in the mesentery of the sigmoid colon, with the review of previous case reports in Japan.