Advertisement

Forensic Science, Medicine and Pathology

, Volume 15, Issue 1, pp 140–142 | Cite as

Lethal small intestinal herniation through a congenital mesenteric defect

  • Karen Heath
  • Roger W. ByardEmail author
Images in Forensics

Abstract

A three-year-old boy with mild symptoms of an upper respiratory tract infection and recent onset vomiting collapsed at home. Resuscitative attempts in hospital were eventually unsuccessful. At autopsy an obstruction of the small intestine, with ischemia, was identified. It had been caused by strangulation of the small intestine through a congenital mesenteric defect. Moderate mesenteric lymphadenopathy, with enlarged lymph nodes in the region of the herniated small intestine, were associated with positive testing for human metapneumovirus and enterovirus. Transmesenteric hernias are a very rare form of internal herniation that have the highest risk of strangulation. Unfortunately in children the presentation may be relatively nonspecific with a precipitate decline towards the end. In the reported case it is possible that mesenteric lymphadenopathy may have contributed to intestinal entrapment by preventing spontaneous reduction.

Keywords

Small intestinal obstruction Congenital mesenteric defect Herniation Sudden death Mesenteric lymphadenopathy 

Notes

Compliance with ethical standards

Ethical approval

This paper was approved by Forensic Science SA management.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Salar O, El-Sharkawy AM, Singh R, Speake W. Internal hernias: a brief review. Hernia. 2013;17:373–7.CrossRefGoogle Scholar
  2. 2.
    Ming YC, Chao HC, Luo CC. Congenital mesenteric hernia causing intestinal obstruction in children. Eur J Pediatr. 2007;166:1045–7.CrossRefGoogle Scholar
  3. 3.
    Merrot T, Anastasescu R, Pankevych T, Chaumoître K, Allessandri P. Small bowel obstruction caused by congenital mesocolic hernia: case report. J Pediatr Surg. 2003;38:E38.CrossRefGoogle Scholar
  4. 4.
    Alaker M, Mathias J. Internal herniation through a defect in the transverse mesocolon. BMJ Case Rep. 2014;2014  https://doi.org/10.1136/bcr-2013-202753.
  5. 5.
    Garignon C, Paparel P, Liloku R, Lansiaux S, Basset T. Mesenteric hernia: a rare cause of intestinal obstruction in children. J Pediatr Surg. 2002;37:1493–4.CrossRefGoogle Scholar
  6. 6.
    Byard RW, Wick R. Congenital mesenteric anomalies and unexpected death. Pediatr Dev Pathol. 2008;15:205–9.Google Scholar
  7. 7.
    Byard RW, Simpson A. Sudden death and intussusception in infancy and childhood -autopsy considerations. Med Sci Law. 2001;41:41–5.CrossRefGoogle Scholar
  8. 8.
    Villalona GA, Diefenbach KA, Touloukian RJ. Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence. J Pediatr Surg. 2010;45:438–42.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Forensic Science SAAdelaideAustralia
  2. 2.School of MedicineUniversity of AdelaideAdelaideAustralia

Personalised recommendations