A unique case of congenital transmesocolic hernia with malrotation in a 25-year-old female: a case report

Abstract

Congenital transmesocolic hernia of the transverse colon is a very rare type of internal hernia. In addition, intestinal malrotation is very rare in adults. Most of these patients do not have clear clinical manifestations. Incidence of congenital transmesocolic hernia of the transverse colon along with malrotation is an unusual phenomenon in medical literature and clinical practice. Here, we report a unique case of a 25-year-old woman diagnosed with transmesocolic hernia of the transverse colon and malrotation of the small intestine, without any history of trauma or previous surgery. The patient underwent surgery, where the hernia orifice was closed and Ladd’s procedure was performed.

Midgut volvulus in a pediatric patient with chronic constipation, congenital intestinal malrotation and internal transmesocolic hernia

“…Plain radiographs are poor at indicating malrotation alone. Patients with malrotation are frequently initially diagnosed with malrotation after suffering intestinal volvulus with obstruction and ischaemia 6. Our patient’s radiograph revealed not only colonic stool burden but increasing pneumatosis intestinalis, indicating bowel necrosis due to ischaemic injury from the midgut volvulus and SMA thrombosis.…”

“…Plain radiographs, US, CT and MRI have been proposed in the diagnosis of transmesocolic hernias. A CT scan can possibly reveal mesenteric vessel stretching, crowding or displacement of the mesenteric trunk towards the transmesocolic hernia 4 6…”

“…Defects can be either congenital, iatrogenic or acquired 4 5. Paraduodenal hernias are the most common type of internal hernia, with pericaecal, intersigmoid, omental and transmesocolic hernias occurring in decreasing frequency 4 6. Transmesocolic hernias typically do not have a hernia sac or soft tissue covering, posing a challenge to detect through imaging with the risk for delayed diagnosis and treatment 4…”

Adult Intestinal Malrotation With Congenital Transverse Meso-Colic Internal Hernia: An Infrequent Cause of Small Bowel Obstruction

“…Further to this procedure, which was done for our patient, a coexisting internal hernia was also identified. The association of internal hernias with congenital intestinal malrotation with simultaneous internal hernia has been cited in the literature with para-duodenal hernias being the most common (53%) (left > right) [ 11 - 14 ], however, in our case we present a patient with a trans-meso-colic hernia (prevalence ranging from 2% to 10%) [ 15 , 16 ] of the ascending colon. Trans-meso-colic hernias are most often represented by those traversing the transverse mesocolon with those of the ascending colon being exceedingly rare, with only three noted in the literature [ 17 ].…”