Traumatic transmesenteric hernia leading to ischemic enterocolitis in an adolescent - case report

Traumatic transmesenteric hernia (TTMH) is an exceptionally rare condition with high morbidity and mortality, particularly in children. It can cause life-threatening complications such as ischemic enterocolitis. Internal hernias, including transmesenteric types, are difficult to diagnose preoperatively and are often discovered during emergency laparotomy.

A 13-year-old girl presented with acute abdominal pain, bilious vomiting, and hypovolemic shock. She had sustained blunt abdominal trauma from a fall two weeks earlier. Initial resuscitation and imaging raised concerns for acute intestinal obstruction. Due to clinical deterioration, an emergency exploratory laparotomy was performed, revealing a transmesenteric hernia with 120 cm of ischemic ileum. Bowel resection and a double-barrel ileostomy were performed. Histopathology confirmed ischemic enterocolitis secondary to the hernia. The patient recovered well and later underwent successful ileostomy reversal.

Transmesenteric hernias are rare, typically congenital or post-surgical, with traumatic cases being extremely uncommon. Diagnosis is challenging due to a lack of specific clinical findings. Delayed intervention increases the risk of bowel ischemia and mortality.

This case highlights the diagnostic difficulty of TTMH and emphasizes the need for a high index of suspicion in trauma patients presenting with acute abdomen. Educating patients with trauma about warning signs & follow up is the recommendation.