Jejunal obstruction due to a variant of transmesocolic hernia: a rare presentation of an acute abdomen

Abstract

Background: Internal hernias include paraduodenal, pericecal, through foramen of Winslow, intersigmoid and retroanastomotic hernias. These hernias could be either congenital or acquired after abdominal surgery. They account for approximately 0.5-5 % of all cases of intestinal obstruction.

Case presentation: A 48-year-old female was admitted to casualty with a history of abdominal distension and vomiting of 3 days duration. An abdominal X-ray supine film showed multiple small bowel loops with air fluid levels. On surgery she was found to have a transmesocolic hernia. The defect in the transverse mesocolon was repaired.

Conclusion: The clinical signs and symptoms of lesser sac hernia are non-specific. These rare lesser sac hernias can be lethal. Therefore, immediate diagnosis and surgery is essential. Although a rare entity, they account for significant mortality form intestinal obstruction. We report an extremely rare case of an internal abdominal hernia through the transverse mesocolon, in a young woman.

Fig. 1

Dilated jejunal loops on X ray abdomen supine film

Fig. 2

Sac of the transmesocolic hernia

Fig. 3

opening and repair of the hernia sac in the supracolic compartment

Fig. 4

Paraduodenal fossa

Fig. 5

Post operative barium meal and follow through showing normal small intestines