A Case of Strangulated Ileus Due to Mesenteric Hiatal Hernia

Abstract

This report concerns acase of strangulated ileus due to incarcerated hiatal hernia of the small intestinal mesentery of a 90-year-old female. On admission she complained of abdominal distention and rightlower abdominaltendernesswithoutany sign of peritoneal irritation, andmildly elevated lactate in arterial blood gas analysis. Her enhanced abdominal CT scan revealed the dilated and unenhanced small bowel outside of the enhanced ascending colon. The result of a peritoneal tap led to a diagnosis ofstrangulated ileus and an emergency operation was performed. Operative findings showed a 60cm long necrotic loop of the ileum was incarcerated into a intestinal mesenteric defect 3 cm in diameter. The necrotic ileum was resected and the hiatus was closed. The postoperative course was uneventful. Hiatal hernia of the small intestinal mesentery in elderly patient is very rare and involves high risk. An enhanced CT scan is essential for prompt and appropriate diagnosis of a strangulated ileus due to incarcerated hiatal hernia of the small intestinal mesentery.