A Case of Transmesenteric Hernia with Two Mesenteric Defects which Behaved Like Hernia Orifices in a 21-year-old Woman

Abstract

A 21-year-old woman who was born with extremely low birth weight presented with abdominal pain and was treated with enema for constipation elseewhere. However, no symptomatic remission was gained, so she was referred to our hospital. When she arrived, she was not fully alert. CT scan revealed a poorly-enhanced distal small bowel with dilated proximal bowel. We performed emergency laparoscopy under preoperative diagnosis of strangulated small bowel obstruction, and confirmed the necrotic strangulation. We converted to laparotomy because it was hard to release the strangulation. Finally, we found that there were two mesenteric defects near the ileocecal valve, which caused the severe and complicated strangulation. A 40-cm segment of the ileum with necrosis was resected, together with the mesenteric defects. Transmesenteric hernia is a rare cause of intestinal obstruction, and it is difficult to diagnose preoperatively. In the case of strangulated intestinal obstruction due to internal hernia, it sometimes lacks peritoneal irritation sign in its onset. When transmesenteric hernia is confirmed, further examination should be considered to find possible other mesenteric defects.