Transmesenteric Internal Hernia Presenting with Strangulation of Bowel in Adult- A Case Report

A congenital transmesenteric hernia is a rare condition characterized by the presence of a congenital defect in the mesentery, allowing bowel loops to herniate through the mesenteric defect. This herniation can lead to bowel strangulation and small bowel obstruction. While more frequently observed in the paediatric population, it is exceptionally uncommon in adults. Overall, internal hernias have an incidence of 0.2 to 0.9%, and congenital transmesenteric hernias make up only 5-10% of all internal hernias. As of May 2016, there were only 18 reported cases of adult congenital transmesenteric hernias in the medical literature. This condition presents with recurrent abdominal pain or acute intestinal obstruction, often accompanied by a mortality rate exceeding 50%. Early intervention and surgical treatment are crucial to prevent severe morbidity and mortality.

We present the case of a 21-year-old female who complained of severe abdominal pain, constipation, and two days of bilious vomiting. Ultrasonography and plain X-rays indicated acute intestinal obstruction. An emergent laparotomy revealed a transmesenteric internal hernia with strangulated small bowel. Fortunately, there was no evidence of gangrene. We successfully untwisted the small bowel and reduced it through the large congenital terminal mesenteric defect. A simple repair of the mesenteric defect was performed.