Internal Herniation Through the Transverse Mesocolon Causing Small Bowel Obstruction: A Case Report.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Imaging

Background:

• Internal hernias are infrequent causes of small bowel obstruction.
• Transmesocolic hernias are particularly rare and present diagnostic difficulties due to nonspecific clinical and radiological findings.

Observation:

• A 68-year-old female with metastatic breast cancer presented with symptoms suggestive of small bowel obstruction.
• Imaging revealed obstruction without a definitive cause.
• Emergency laparotomy identified a transmesocolic hernia with two jejunal loops incarcerated through a mesocolic defect.

Findings:

• The herniated bowel loops were viable and successfully reduced.
• The mesocolic defect was repaired without the need for bowel resection.
• The defect was likely acquired, possibly related to peritoneal carcinomatosis or metastatic disease.

Implications:

• Transmesocolic hernias require consideration in patients with small bowel obstruction, particularly those with known peritoneal malignancy.
• Early surgical intervention is crucial to prevent complications like bowel ischemia and infarction.
• High clinical suspicion and timely operative management are key for favorable outcomes in these rare cases.