Congenital Middle Mesocolic Hernia: A Rare Cause of Neonatal Intestinal Obstruction

Abstract

Congenital mesocolic hernia is an extremely rare, but serious cause of intestinal obstruction in children. Given the rarity of this condition, delays in diagnosis and management can have catastrophic consequences. Congenital mesocolic hernias are usually caused by an abnormal rotation of primitive mid-gut and are divided into left and right congenital mesocolic hernias. We report and discuss the clinical and radiological features and management of a neonate with an extremely rare variant, congenital middle mesocolic hernia along with a literature review of this rare condition.

Keywords: Congenital; Middle mesocolic hernia; Neonatal intestinal obstruction.

Figure 1: Plain abdominal film showing a single dilated bowel loop in the centre of the abdomen immediately inferior to the body of the stomach. Inset shows UGI contrast study that demonstrated the contrast flowing freely into a markedly distended duodenum as far as the DJ flexure, which appeared in the normal position. A small amount of contrast entered a normal calibre jejunum.

Figure 2: Intraoperative picture which demonstrates a mobile caecum which was near the liver (solid white arrow), and a dilated duodenum (dashed black arrow) and D-J flexure herniating through a defect in the transverse mesocolon (solid black arrow), with a normal calibre jejunum (dashed white arrow) distally.

Figure 3: Diagrammatic representation of intra-operative findings of (A) a defect in the transverse mesocolon left of the middle colic artery with the D-J flexure herniated through this defect (B) Arrow heads showing the reduction of D-J flexure, Duodenum and Jejunum out of the hernia defect resulting in the D-J flexure being in a malrotated position.