[Transmesenteric Hernia: A Rare, Surgically Treatable Cause of Chronic Gastrointestinal Symptoms]

Internal hernias are rare causes of gastrointestinal obstruction and typically present acutely. Chronic courses are uncommon and pose a diagnostic challenge. We report on a 78-year-old female patient with progressive weight loss of 27 kg over two years (BMI 18.1 kg/m² upon initial presentation) and chronic postprandial symptoms. Abdominal computed tomography revealed a pronounced whirl sign at the level of the superior mesenteric artery and vein, without signs of intestinal obstruction and with caudal traction of the stomach. The whirl sign is defined as a spiral configuration of mesenteric vessels indicating mesenteric rotation. Following prehabilitation, diagnostic laparoscopy confirmed a transmesenteric hernia. Via laparotomy the small intestine was repositioned and the mesenteric defect closed. This case highlights the importance of considering surgical exploration and treatment, even in patients with long-standing symptoms. The whirl sign may be a key diagnostic clue, even outside emergency contexts.