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Intestinal obstruction due to axial twisting of bowel in transmesenteric hernia
Insights
A large mesenteric defect in a baby with gastroschisis led to bowel obstruction due to twisting. This case highlights that even wide mesenteric defects require closure to prevent serious complications.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Congenital Abnormalities
Background:
- Gastroschisis is a congenital defect where the intestines exit the body through an opening near the belly button.
- Mesocolon defects can occur in conjunction with abdominal wall defects.
- The management of associated mesenteric defects requires careful consideration.
Observation:
- A neonate with gastroschisis presented with an unrepaired, large mesenteric defect near a segment of colon.
- The entire length of bowel proximal to the defect spontaneously traversed the mesenteric rent.
- This event resulted in midgut volvulus, causing obstruction of the affected colon segment.
Findings:
- Large mesenteric defects, even if too wide for bowel strangulation, pose a significant risk.
- Bowel intussusception and volvulus can occur secondary to mesenteric defects.
- Obstruction can develop due to the twisting of the bowel along its long axis.
Implications:
- Mesenteric defects associated with gastroschisis should be surgically closed.
- Prompt closure of mesenteric defects is crucial to prevent bowel obstruction and ischemia.
- This case underscores the importance of vigilant surgical assessment and intervention for all mesenteric defects.
Abstract:
A baby, born with gastroschisis, had an unrepaired large aperture in the mesocolon close to a short segment of colon. One day, the entire length of bowel proximal to the defect traversed the rent. The free segment of colon was affected by the resulting twist along the long axis of the bowel and became obstructed. A large mesenteric defect, albeit too wide to strangulate the bowel, is not totally innocuous and should always be closed.