A Case of Transmesocolonic Hernia in the Mesentery of the Transverse Colon with Bowel Protrusion through Omentum Laceration

Abstract

A 67-year-old woman without history of abdominal surgery visited the emergency clinic in our hospital because of lower abdominal pain and vomiting. No symptomatic remission was gained with taking analgesic and antiflatulent, so she visited our hospital again. She was diagnosed with small intestinal obstruction and an umbilical hernia of which content was omentum by abdominal computed tomographic scan. We conducted conservative long-tube therapy, but her symptoms got worse and we decided to carry emergency surgery. At first we opened the umbilical hernia sac. Laparotomy showed an oval defect about 3cm in diameter in the mesentery of the transverse colon, and an about 100-cm small intestine had invaginated into the omental brusa through the defect and strangulated. The invaginated small intestine turned over the transverse colon, through a lacerated hole of the omentum. The strangulated small bowel was resected, the mesentery defect was sutured and the umbilical hernia was repaired. In this case, we speculated that the omentum was dragged and fixed by the umbilical hernia and the small bowel which invaginated into the omental brusa became dilated and lacerated the omentum.