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. 2015:2015:853297.
doi: 10.1155/2015/853297. Epub 2015 Jul 12.

Laparoscopic Repair of Internal Transmesocolic Hernia of Transverse Colon

Tomokazu Kishiki  1 , Toshiyuki Mori  1 , Yoshikazu Hashimoto  1 , Hiroyoshi Matsuoka  1 , Nobutsugu Abe  1 , Tadahiko Masaki  1 , Masanori Sugiyama  1
Affiliations

Laparoscopic Repair of Internal Transmesocolic Hernia of Transverse Colon

Tomokazu Kishiki et al. Case Rep Surg. 2015.

Abstract

Introduction. Internal hernias are often misdiagnosed because of their rarity, with subsequent significant morbidity. Case Presentation. A 61-year-old Japanese man with no history of surgery was referred for intermittent abdominal pain. CT suggested the presence of a transmesocolic internal hernia. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We found internal herniation of the small intestine loop through a defect in the transverse mesocolon, without any strangulation of the small intestine. We were able to complete the operation laparoscopically. The patient's postoperative course was uneventful and the patient was discharged on postoperative day 6. Discussion. Transmesocolic hernia of the transverse colon is very rare. Transmesocolic hernia of the sigmoid colon accounts for 60% of all other mesocolic hernias. Paraduodenal hernias are difficult to distinguish from internal mesocolic transverse hernias. We can rule out paraduodenal hernias with CT. Conclusion. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We report a case of a transmesocolic hernia of the transverse colon with intestinal obstruction that was diagnosed preoperatively and for which laparoscopic surgery was performed.

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Figures

Figure 1
Figure 1
A radiograph shows the dilated small bowel in the upper quadrant.
Figure 2
Figure 2
An axial computed tomography scan shows an encapsulated cluster of dilated small bowel loops (arrow) occupying the upper quadrant. A small bowel loop is ascending the left colic artery (arrowhead).
Figure 3
Figure 3
A gastrointestinal series with barium contrast showing dilated loops of the small bowel in the upper quadrant, delay of contrast, or the point of obstruction (arrow).
Figure 4
Figure 4
Operative findings. (a) Illustration. (b) The ileum is herniated through the mesenteric defect. (c) The small intestine is pulled out through the mesenteric defect. (d) Closure of the mesenteric defect.
See this image and copyright information in PMC

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