Congenital trans-mesenteric herniation: a rare cause of small intestine strangulation in adults
A 21-year-old woman who was otherwise healthy before presented with severe abdominal pain. The pain was generalized, severe, acute onset and continuous. She was also found to have multiple episodes of vomiting for a period of 24 h. Otherwise, she had no fever, no history of previous abdominal surgery, no other co-morbids and no trauma.\nOn examination she was drowsy, tachycardic with a pulse rate of 120 beats/min, BP 130/78 mmHg, temperature 37.0°C, dehydrated and respiratory rate of 24 breaths/min. An abdominal examination revealed distended abdomen, generalized abdominal tenderness and guarding. Bowel sounds were absent.\nLaboratory investigations results were normal, except for an elevated white blood cell count of 16 000/mm3.\nIn view of generalized peritonitis, the abdomen was explored through an emergency midline laparotomy after initial resuscitation.\nUpon entering the peritoneal cavity, 2 l of hemorrhagic fluid was drained. A loop of ileum had herniated through a small mesenteric defect. A total of 180 cm ileum noted to be gangrenous with loss of peristalsis and absent pulsations (Fig. ). Terminal ileum and the ileocecal junction were also nonviable. Pulsations of mesenteric vessels were intact. The mesenteric defect measuring 3 × 3 cm located about 4 cm from the mesenteric edge of mid-jejunum. There was no evidence of malrotation. A limited right hemicolectomy with extensive gangrenous small bowel resection was performed and a stapled side-to-side functional anastomosis created. The mesenteric defect mentioned earlier was closed with interrupted sutures. The patient recovered well from the surgery. She was allowed orally on day 3 post surgery (Figs –).