Congenital adult transmesenteric hernia as small bowel obstruction

Abstract

Aim-Background

Internal hernias are a rare cause of intestinal obstruction in adults with few reported cases in the published literature. Congenital transmesenteric hernias constitute only an estimated 5-10% of all internal hernias. We report the rare case of a 16-year-old female with a spontaneous transmesenteric hernia of the jejunum and proximal ileum due to a congenital mesenteric defect. We also conducted a review of the literature to establish the rarity of the condition and the management of emergency cases.

Methods

We report the case of 16-year-old female who presented to the emergency department complaining of sudden generalized abdominal pain, non-passage of faeces and flatus, and a 2-day history of multiple episodes of bilious vomiting. There was no history of surgery and no comorbidities. An emergency laparotomy was performed. The mesenteric defect, measuring 3 cm in size, was detected in the terminal ileum at about 2 feet from the ileocaecal region. The gangrenous bowel along with the mesenteric defect was resected and a primary ileo-ileal anastomosis was performed. In May 2016, we also conducted a search of the PubMed database. All case reports and case series were included without restriction in terms of language or publication status.

Results

Only 18 adult case reports (7:11 male to female ratio) of bowel obstruction secondary to congenital mesenteric defects had been documented in the published literature up to May 2016, of which one was diagnosed at autopsy, and seven were recorded as having developed bowel ischaemia.

Conclusion

Transmesenteric hernia is a rare cause of small bowel obstruction as it constitutes only 8% of internal hernias. A congenital mesenteric defect should be considered as one of the differential diagnoses in a relatively young patient with bowel obstruction without an external hernia, previous abdominal surgery or trauma. Surgical decision-making is made on the basis of clinical findings of intestinal strangulation or ischaemia, and emergency laparotomy should be performed without preoperative diagnosis of such a rare disease.