Abstract
A 76-year-old man with no history of trauma or laparotomy visited a nearby physician with a chief complaint of abdominal pain. He was diagnosed with intestinal obstruction and hospitalized. The next day, symptoms worsened and he was transferred to our hospital. On arrival at the hospital, the entire abdomen showed board-like induration. Abdominal contrast-enhanced computed tomography showed a slightly enhanced loop of small bowel, images of clustered mesenteric vessels, and ascites. Strangulated ileus was diagnosed, and emergency surgery was performed. Laparotomy revealed hemorrhagic ascites and a necrotic gastrointestinal tract. An abnormal hiatus was found in the ileal mesentery, 30 cm from the ileocecal valve ; the ileum was impacted, twisted, and necrotic, so 100 cm of the ileum was excised. After surgery, he developed aspiration pneumonia and needed to undergo antibiotic treatment and minitrach insertion, but his condition improved and he was discharged on postoperative day 24. Transmesenteric hernia is a kind of internal hernia that most commonly occurs in children, and is rare in the elderly. We report here, with a discussion of the literature, our experience with a case of strangulated ileus due to transmesenteric hernia onset in an elderly patient.
