Congenital Transmesenteric Hernia—Importance of a Timely Intervention

Abstract

<jats:title>Abstract</jats:title><jats:p>Transmesenteric hernia is a rare cause of small bowel strangulation in adults. Our patient was a 61-year-old previously healthy male, who presented with vomiting and abdominal pain with no surgical history and no trauma in the past. Computed tomography with contrast enhancement was suggestive of superior mesenteric vein (SMV) compression without any obvious cause. The emergency exploratory laparotomy revealed venous congestion of small bowel caused by a transmesenteric hernia with the herniated loop compressing the SMV. On reducing the hernia, complete reversal of the bowel congestion was noted and small bowel resection was averted. A high index of suspicion for a transmesenteric hernia in small bowel obstruction of unknown etiology and a timely surgical intervention are must for a good clinical outcome.</jats:p>

Internal hernia through dual defects: defects in transverse mesocolon and lesser omentum a rare presentation: case report

“…Protrusion of the viscus through intra-abdominal apertures leads to small bowel obstruction, strangulation, or bowel gangrene. 1 Internal hernia, might be congenital or acquired and the most common are para-duodenal hernias seen in around 53% of the patients. 1,5,6 Trans-mesenteric hernias are a rare entity with a bimodal distribution, occurring in both adults and pediatric populations.…”

“…1 Internal hernia, might be congenital or acquired and the most common are para-duodenal hernias seen in around 53% of the patients. 1,5,6 Trans-mesenteric hernias are a rare entity with a bimodal distribution, occurring in both adults and pediatric populations. 2 One popular theory relates the cause to prenatal thinning of mesenteric leaves due to prenatal intestinal ischemia and other causes would be intraperitoneal inflammation, trauma, fenestration of the mesentery by colon during embryological displacement into the umbilical cord.…”

“…Internal hernias are a rare cause of intestinal obstruction and have the potential to cause bowel ischemia, gangrene leading to high morbidity and mortality. 1 Diagnosis is elusive even in the acute setting and can be diagnosed only during surgery. 2,3 Of the internal hernia's trans-mesenteric hernia is a rare entity and is seen in 5-10% of the internal hernias.…”

Congenital Transmesenteric Hernia With Closed-Loop Small Bowel Obstruction and Intestinal Gangrene in an Adult

“…The first instance of a congenital transmesenteric hernia presenting in an adult was reported by Moulay et al in 1971 [4]. The incidence of congenital IHs presenting with SBO and bowel ischemia in adulthood is extremely rare, with <30 case reports in published literature up to 2023, to the best of our knowledge [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Since there are so few case reports documented and published, no systematic reviews outlining the presentation, ideal course of management, or outcomes are available for comparison.…”

“…Congenital IHs are rarer, even more so in adults, accounting for barely 8% of all iHs, usually due to embryological or developmental defects, often undiagnosed, and require a high index of clinical suspicion [2]. Congenital IHs are a common cause of SBO in infants and pediatric age groups, but are extremely rare among adults, with only 28 cases documented in published literature [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. They often remain undiagnosed, usually being an intra-operative diagnosis, and hence require a low threshold for surgical intervention.…”