Korean J Gastroenterol.  2009 May;53(5):320-323. 10.4166/kjg.2009.53.5.320.

A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect

• Park CY
• Kim JC
• Choi SJ
• Kim SK

• KMID: 1767695
• DOI: http://doi.org/10.4166/kjg.2009.53.5.320

Abstract

Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.

Keyword

Intestinal obstruction; Internal hernia; Transmesenteric; Gangrene; Child

MeSH Terms

Child
Diagnosis, Differential
Female
Gangrene
Hernia/complications/*diagnosis/radiography
Humans
Ileal Diseases/*diagnosis/radiography/surgery
Intestinal Obstruction/etiology/radiography
Intestine, Small/*pathology/surgery
Mesentery
Tomography, X-Ray Computed

Figure

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  Fig. 1. Plain erect abdominal X-ray showed multiple dilated loops of the small bowel.

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  Fig. 2. Abdominal CT scan showed bulky amount of ischemic small bowel loops and ascites in the abdominal cavity.

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  Fig. 3. Intraoperative findings. (A) Long segment of the strangulated ileum was gangrenous and normal appearing loops of the jejunum were dilated. (B) After reduction, a large round mesenteric defect near the terminal ileum with gangrenous loops of the entire ileum was seen.

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