A Pediatric Case of Strangulated Ileus Due to a Huge Congenital Mesenteric Defect

Abstract

Internal hernia due to a congenital mesenteric defect can lead to intestinal obstruction or necrosis caused by strangulation and, in severe cases, to death as it has no hernia sac and allows a large portion of the small intestine to pass through its defect. However, the diagnosis has been considered to be difficult and the only way to confirm the diagnosis is via laparotomy. We experienced treating a case of a 7-year-old girl without any previous medical history, who was diagnosed as having a strangulated ileus due to internal hernia caused by a huge congenital mesenteric defect. She was referred to our hospital presenting with abdominal pain, vomiting and hyperglycemia (almost 600 mg/dl), and was suspected of having diabetic ketoacidosis. After some testing including abdominal CT scan with contrast, her above-mentioned diagnosis was confirmed and she underwent emergency surgery. During the operation, a mesenteric defect as huge as 15 cm in diameter was found over 235 cm of her small intestine, through which almost her entire small intestine passed. As a result of this condition, her intestine twisted and became necrotic. Therefore, we performed partial resection of the small intestine with ileocecal valve. The length of the residual intestine was 150 cm. After the surgery, she suffered from mild and frequent diarrhea for a while, but the symptom improved gradually and she can now eat sufficiently to maintain her body weight.