Laparoscopic Repair of Internal Transmesocolic Hernia of Transverse Colon

Abstract

Introduction. Internal hernias are often misdiagnosed because of their rarity, with subsequent significant morbidity. Case Presentation. A 61-year-old Japanese man with no history of surgery was referred for intermittent abdominal pain. CT suggested the presence of a transmesocolic internal hernia. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We found internal herniation of the small intestine loop through a defect in the transverse mesocolon, without any strangulation of the small intestine. We were able to complete the operation laparoscopically. The patient's postoperative course was uneventful and the patient was discharged on postoperative day 6. Discussion. Transmesocolic hernia of the transverse colon is very rare. Transmesocolic hernia of the sigmoid colon accounts for 60% of all other mesocolic hernias. Paraduodenal hernias are difficult to distinguish from internal mesocolic transverse hernias. We can rule out paraduodenal hernias with CT. Conclusion. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We report a case of a transmesocolic hernia of the transverse colon with intestinal obstruction that was diagnosed preoperatively and for which laparoscopic surgery was performed.

Hernia paracecal, reto diagnóstico y quirúrgico: reporte de caso y revisión de la literatura

“…La tomografía se considera el método diagnóstico de referencia en el estudio de las hernias internas 11,23,24 , pues permite evidenciar un conglomerado ovoide de asas yeyunales que desplazan el estómago y el colon según su localización, alteración del curso de los vasos del yeyuno o mesentéricos, presencia de un saco herniario o de puntos de transición en las asas intestinales, e íleo inespecífico 22 .…”

Transmesocolic hernia with sigmoid colon strangulation without surgical history: a series of two case reports

“…The preoperative diagnosis of transmesenteric hernias preoperative is quite hard, however abdominal CT might help: engorgement of the mesenteric vascular structures; abnormal right or left displacement of the colon; dilation of prestenotic small bowel loops or colon; absence of intraluminal contrast progression associated with distension content [ 1 , 2 , 5 ]. However, the identification of the type of internal hernia base on clinical and radiologic findings is often impossible [ 2 ].…”

“…Compared to other subtypes of internal hernias, transmesocolic more often develop complications such as volvulus(30%), strangulation, ischemia(40%) and perforation [ 2 , 5 ]. In our series, both cases were associated with volvulus and strangulation.…”

“…In our series, both cases were associated with volvulus and strangulation. Unfortunately, as our series document, the majority of times there are intestinal necrosis, even if the laboratory analysis is relative normal, with the need of intestinal resection [ 1 , 2 , 5 ]. Our series also demonstrate that if the colon is strangulated, the majority of times is colon sigmoid, possible due to a more redundant mesocolon.…”

Strangulated transmesosigmoid hernia as a late complication of a fall from a height: A case report

“…Preoperative diagnosis of a transmesosigmoid hernia is quite difficult because of the low incidence and unpredictable symptoms of this condition. When an internal hernia is suspected but cannot be confirmed by preoperative imaging studies, laparoscopic herniorrhaphy has the advantage of facilitating simultaneous diagnosis and surgical intervention [15] , [16] . This avoids extensive preoperative studies, minimizes the time to operative intervention, reduces morbidity, and shortens the postoperative hospital stay [17] .…”