Transmesenteric hernia with closed-loop small bowel obstruction: A case report

Transmesenteric hernia is a subtype of internal abdominal hernia (IAH) and a rare cause of small bowel obstruction in adults. Difficulty in reaching a definitive diagnosis due to non-specific clinical and imaging findings often cause life-threatening bowel ischemia.

We report a case of a 37-year-old female who presented with clinical and imaging features of small bowel obstruction. She underwent an emergency laparotomy where the diagnosis of transmesenteric hernia causing closed-loop obstruction was made. The non-viable portion of the intestine was resected, anastomosis of the ileum along with the closure of the mesenteric defect was performed.

IAH is the protrusion of abdominal viscera, most commonly small bowel loops through a peritoneal or mesenteric defect into the abdominal or pelvic cavity. Considered common in children, it is rare in adults and is most common after abdominal surgeries like Roux-en-Y gastric bypass surgery. Clinical features and imaging findings are non-specific causing delay in the diagnosis.

A high index of suspicion is required while assessing the patient with symptoms suggestive of acute bowel obstruction as the preoperative diagnosis of a transmesenteric hernia is challenging.