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Internal herniation through a defect in the transverse mesocolon
Medhat Alaker1, Jegadish Mathias
1Department of General Surgery, Withybush Hospital, Haverfordwest, Pembrokeshire, UK.
BMJ Case Reports
|February 26, 2014
Summary
This case report details a rare congenital transverse mesocolon hernia causing acute intestinal obstruction in an adult. Surgical repair involved reducing the herniated bowel and closing the defect.
Area of Science:
- Gastroenterology
- Surgical Anatomy
- Radiology
Background:
- Internal hernias are uncommon causes of intestinal obstruction, accounting for 5.8% of cases.
- Congenital transverse mesocolon hernias in adults are exceptionally rare, presenting diagnostic and surgical challenges.
Observation:
- A CT scan revealed classic signs of internal herniation, including the 'whirlpool sign', bowel loop crowding, and absence of the cecum from the right iliac fossa.
- The patient presented with acute intestinal obstruction, necessitating urgent surgical intervention.
Findings:
- Intraoperative findings confirmed a congenital defect in the transverse mesocolon.
- The terminal ileum, cecum, and proximal ascending colon had herniated through this defect and undergone a 360° volvulus.
Implications:
- This case highlights the importance of recognizing rare internal hernias on imaging for timely diagnosis.
- Successful surgical management involved bowel derotation, reduction, defect repair, and fixation, offering a potential treatment pathway for similar presentations.
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