Neonatal obstructed Treitz's hernia with abdominal cocoon simulating volvulus neonatorum

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Gastrointestinal Surgery

Background:

• Congenital obstructed Treitz's hernia is a rare cause of intestinal obstruction in neonates.
• Bilious vomiting in newborns necessitates prompt diagnosis and management of potential surgical emergencies.
• Abdominal cocoon formation can complicate internal hernias, mimicking other conditions like midgut volvulus.

Observation:

• A case presentation of a neonate with congenital obstructed Treitz's hernia.
• Clinical presentation included significant bilious vomiting.
• Imaging studies, including plain radiographs and contrast studies, were crucial for diagnosis.

Findings:

• Internal herniation within a right paramesocolic hernia sac led to abdominal cocoon formation.
• The abdominal cocoon simulated findings consistent with volvulus neonatorum.
• Surgical intervention included exploratory laparotomy, hernia reduction, and Ladd's procedure for malrotation.

Implications:

• This case highlights the importance of considering Treitz's hernia and abdominal cocoon in the differential diagnosis of neonatal intestinal obstruction.
• Prompt surgical management, including correction of associated malrotation, leads to favorable outcomes.
• Radiological assessment plays a vital role in pre-operative diagnosis and surgical planning.