Advances in Pediatric Surgery

"Internal hernia"

Case Reports

[English]

Transmesenteric internal hernia through a mesenteric defect presenting as small bowel obstruction in a 15-year-old boy: a case report and literature review: Jinyoung Park; Received June 30, 2026 Accepted July 29, 2026 Published online October 16, 2026; DOI: https://doi.org/10.13029/aps.2026.00122 [Epub ahead of print]

Abstract
PDF

Internal hernia is an uncommon cause of small bowel obstruction, especially in children and adolescents with no history of abdominal surgery. Among its subtypes, transmesenteric hernia through a mesenteric defect is rare but clinically important because it can lead to closed-loop obstruction, bowel ischemia, and intestinal strangulation. Early diagnosis and timely surgical treatment are therefore essential. A previously healthy 15-year-old boy was transferred to our emergency department with left upper quadrant abdominal pain and vomiting that had persisted for 2 days. His vital signs were stable on arrival, and physical examination showed only mild left upper quadrant tenderness, with no abdominal distension. Abdominal computed tomography revealed two transition points in the mid-abdomen and dilatation of the left-sided small bowel loops, findings suggestive of closed-loop obstruction. Emergency laparoscopic exploration showed two segments of small bowel herniated through a defect in the jejunal mesentery. Although laparoscopic reduction was attempted first, marked bowel dilatation and the small size of the mesenteric defect prevented safe reduction. The procedure was therefore converted to open surgery through a periumbilical incision. The incarcerated bowel loops were carefully reduced, and the mesenteric defect was closed with interrupted sutures. The patient developed mild postoperative ileus, which resolved with conservative treatment. At the 1-year follow-up, he remained well, with no recurrence or postoperative sequelae. Transmesenteric internal hernia caused by a mesenteric defect should be considered in adolescents with small bowel obstruction, even when they have no history of abdominal surgery. Prompt surgical exploration and closure of the mesenteric defect may prevent bowel ischemia and strangulation and support favorable outcomes.

244 View
2 Download

[English]

Transmesenteric Hernia: Seong-Chul Kim, In-Koo Kim; J Korean Assoc Pediatr Surg 1996;2(2):148-150. Published online December 31, 1996; DOI: https://doi.org/10.13029/jkaps.1996.2.2.148

Abstract
PDF

Transmesenteric hernia, a type of internal hernias, is a rare cause of intestinal obstruction. This intraperitoneal hernia has no sac and is formed by protrusion of a loop of bowel through an aperture in the mesentery. Incarceration leads to intestinal obstruction and subsequently, strangulation and gangrene of varing lengths of intestine. This is a case report of 4-year-old girl with transmesenteric herniation of the terminal ileum through a defect in its own mesentery. Strangulation of the affected bowel necessitates resection and primary anastomosis with repair of mesenteric defect. The postoperative course was uneventful. Acute intestinal obstruction in the absence of an external hernia and with no history of a previous surgical procedure suggests the possibility of an internal hernia, especially if the patient has a history of chronic intermittent abdominal distress.

Citations

Citations to this article as recorded by

A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect
Chan Yong Park, Jung Chul Kim, Soo Jin Na Choi, Shin Kon Kim
The Korean Journal of Gastroenterology.2009; 53(5): 320. CrossRef