Small Bowel Obstruction Caused by an Unusual Variant of Paraduodenal Hernia. The “Middle Congenital Mesocolic Hernia”: Case Report

Abstract

Internal hernias account for 0.2-0.9 % of all small bowel obstructions and are associated with a mortality rate of 50 % when strangulation is present. Congenital mesocolic hernias, traditionally called paraduodenal hernias, caused by an abnormal rotation of the primitive midgut, are the most common type of internal hernia. They can be divided into three types: the right and the left congenital mesocolic hernias, accounting for the 25 and 75 % of all cases, respectively, and the extremely rare transverse congenital mesocolic hernia. A high preoperative misdiagnosis rate has been reported and a surgical exploration is recommended to identify strangulation. The present case report describes a case of small bowel obstruction due to an unusual variant of congenital mesocolic hernia never previously reported in the literature. We discuss the clinical appearance, pathogenesis, diagnosis, and treatment of the case, with a brief review of the literature focused on the pathogenesis and management of mesocolic congenital hernias.

Congenital middle mesocolic hernia: A case report

“…15 Congenital middle mesocolic hernias occur through a congenital rent in the middle portion of the transverse mesocolon to the left of the middle colic artery without malrotation of the gut as in our case. In the transverse congenital mesocolic hernia, the transverse colon is invaginated behind the superior mesenteric artery and the mesentery.…”

“…[11][12][13][14] Middle mesocolic hernia is a rare entity. 15 Thus far, only one or two incidents have been reported in the medical literature. Intestinal injury has been found in 5-16 per cent of blunt abdominal trauma.…”

Congenital Middle Mesocolic Hernia: A Rare Cause of Neonatal Intestinal Obstruction

“…In congenital transverse mesocolic hernias, the transverse colon is invaginated behind the superior mesenteric artery and the mesentery, with the duodenum lying anterior to the superior mesenteric artery. However, congenital middle mesocolic hernias protrude into a congenital defect in the middle portion of the transverse mesocolon to the left of the middle colic artery is extremely rare, as was seen in our case [6].There are 9 reported cases of congenital mesocolic hernias in the literature, and only one of them was a neonate who in fact was found to have right mesocolic hernia [5][6][7][8][9][10].…”

“…This is because the bowel herniates through a very small rent in the mesentery with no sac, causing a tight ring of compression at this point. Also as these cases have a normal rotated gut and fixed D-J flexure, there is limited movement of the bowel within the defect leading to strangulation and incarceration, as seen in the adult case [10]. This was also the mechanism for complete transection of the small intestine due to blunt abdominal injury in the 14-year-old child [6].…”

Paraduodenal hernias in children: Etiology, treatment, and outcomes of a rare but real cause of bowel obstruction

“…Congenital PDH is divided into three types, left PDH which accounts for 75% of the cases, right PDH accounting for the remaining 25% and the extremely rare transverse PDH [9]. The left PDH is thought to be caused by the in utero herniation of the small intestine through the left paraduodenal fossa of Landzert.…”