Congenital transmesocolic internal hernia as a cause of sudden death - autopsy case report

Internal abdominal hernias (IAHs) are rare causes of intestinal obstruction and unexpected death, with transmesocolic hernias being particularly uncommon and typically diagnosed in children. Autopsy-confirmed congenital cases in the elderly are exceptionally rare.

An 89-year-old woman presented with a three-day history of abdominal pain and constipation. Despite supportive treatment, her condition rapidly deteriorated, leading to death within nine hours of hospital admission. Autopsy revealed a 180 cm segment of necrotic small intestine herniated through a 3 cm smooth-edged defect in the transverse mesocolon, consistent with a congenital transmesocolic hernia. No prior abdominal surgeries, trauma, or intra-abdominal inflammation were noted.

Transmesocolic hernias are a rare subset of IAHs and can be life-threatening due to bowel strangulation and ischemia. Congenital mesenteric defects are typically identified in pediatric populations, making this elderly case highly unusual. The nonspecific clinical presentation often delays diagnosis, and imaging may fail to detect small mesenteric defects, contributing to high mortality rates.

This case represents the first reported autopsy-confirmed congenital transmesocolic hernia in an elderly individual. It emphasizes the importance of considering rare congenital anomalies in differential diagnoses of acute abdomen and unexplained sudden death, even in the absence of surgical or traumatic history.