Transmesosigmoid hernia in a 30-year-old patient: A rare case report and surgical management

Internal hernias (IHs) are uncommon, representing under 1 % of all cases, and are hard to diagnose early, often leading to discovery during surgery.

A 30-year-old patient with no prior surgeries presented with sudden severe abdominal pain and vomiting. Examination showed generalized defence and hyperactive bowel sounds. Imaging suggested bowel obstruction. Emergency surgery revealed a large internal hernia through the right leaflet of an elongated sigmoid mesocolon containing the entire small bowel. The bowel was viable and reduced, followed by sigmoid resection and temporary colostomy. The patient recovered well with no major complications and was discharged on day eight.

Internal abdominal hernias are a rare cause of small bowel obstruction (SBO), with transmesosigmoid hernias (TMSHs) being one of the less common subtypes. These hernias occur due to defects in the sigmoid mesocolon and can present with acute abdominal pain and signs of bowel obstruction. Although both congenital and acquired factors have been suggested, the exact cause remains unclear. Prompt diagnosis is crucial to avoid serious complications such as strangulation, gangrene, and perforation. Multidetector CT scans have greatly improved preoperative diagnosis by providing detailed images of internal structures. Surgical repair, either laparoscopic or open, is essential for treatment, with laparoscopy offering benefits in terms of recovery and complications.

This report emphasizes the rarity of TMSHs and difficult to diagnose due to nonspecific symptoms. Moreover, highlights the value of early diagnosis and timely surgical intervention to prevent complications.