A Preoperatively Diagnosed Case of Mesenteric Hiatus Hernia Requiring Small Bowel Resection

Abstract

A 15-year-old boy complaining of abdominal pain visited a clinic and underwent an enema for constipation. However, his symptoms did not improve, so he was referred to our hospital. Gastroenteritis was suspected, and he was hospitalized owing to a lack of any specific findings concerning his clinical symptoms and examination results. The symptoms worsened after hospitalization, and he ultimately required analgesics of not only acetaminophen but also pentazocine. Enhanced computed tomography (CT) 45 h after the onset showed a strangulated intestinal obstruction due to mesenteric hiatus hernia. He then underwent emergent laparotomy. On entering the abdominal cavity, a mesenteric defect was found with incarceration in a 90-cm segment of the necrotic distal ileum. The necrotic small intestine was resected, primary anastomosis was performed, and the mesenteric defect was closed. The postoperative course was uneventful, and he was discharged 11 days after the operation without any complications. The mesenteric hiatus hernia was difficult to diagnose preoperatively. This case was diagnosed by preoperative enhanced CT, but the patient required small bowel resection because of the delayed diagnosis. Bowel obstruction without a history of laparotomy is often difficult to diagnose. We should pay close attention to not the need for analgesic medication but also changes in the symptoms in cases of constant abdominal pain in order to prevent the need for bowel resection.