A transmesenteric hernia as a reason for small bowel obstruction in an adult: a case report

Transmesenteric hernia is a subtype of internal abdominal hernias (IAHs) that occurs through mesenteric defects and accounts for 5-10% of all internal hernias.

We present a case of a 20-year-old woman, 6 weeks pregnant, who underwent a laparoscopic appendectomy 2 months prior and presented with acute abdominal pain. She also reported multiple episodes of vomiting and complete constipation. She exhibited abdominal distension and diffuse tenderness on examination. The ultrasound revealed distended small bowel loops. Exploratory laparoscopy revealed ileal infarction. An emergency laparotomy was decided, and during the procedure, a transmesenteric hernia was identified through the mesentery of the distal ileum. The non-viable portion of the intestine was resected, the ileal stump was closed, and a jejunocecal anastomosis was performed. The recovery was rapid. An incomplete miscarriage occurred and was managed with cervical dilatation and uterine curettage.

IAHs occur when abdominal viscera protrude through mesenteric or peritoneal defects. They may arise from either congenital anomalies or postsurgical changes. Because symptoms and imaging findings are often nonspecific, the diagnosis is challenging. The majority of transmesenteric hernias are reported as emergency cases. The surgical approach involves prompt laparotomy, reduction of the hernia, and closure of the defect.

This case underscores the rapid progress of a transmesenteric hernia to bowel ischemia once strangulated, and the unavailability of definitive radiological or laboratory findings, emphasizing the need to maintain a heightened level of suspicion. Prompt diagnosis and intervention are essential to prevent significant morbidity associated with this critical surgical condition.