Congenital Mesenteric Defect with Transmesenteric Hernia in Children: A Case Series

Abstract

Transmesentric hernias are a type of internal hernia, in which there is herniation of bowel loops through a defect in the mesentery. They present with a wide variety of symptoms without any specific radiological features, leading to a delay in diagnosis and high mortality rate. Here, we present a case series of four patients with this rare but fatal cause of small bowel obstruction. Three children presented to the emergency department with small bowel obstruction. The other baby was a preterm neonate with an antenatal scan showing small bowel obstruction. All children underwent emergency laparotomy and were found to have a mesenteric defect with herniation and gangrene of the small bowel. Resection anastomosis of the gangrenous segment and closure of the mesenteric defect were done. The differential for small bowel obstruction in children should include transmesentric hernia. Laboratory or imaging investigations are often inconclusive. Timely exploration can save lives in this rare but life-threatening condition.

Figure 1

Plain X-ray abdomen - Erect. (a) 54 days old with distended abdomen and paucity of bowel gas, (b) 2 years old with distended abdomen showing dilated proximal loops and paucity of distal bowel gas

Figure 2

Intraoperative findings in a 3-day-old child: (a) Volvulus with gangrenous bowel loops seen on laparotomy (b) Mid ileal mesenteric defect with around 40 centimetres of ileal gangrene. Yellow star-mesenteric defect; White arrow-proximal healthy small bowel; Black arrow-gangrenous small bowel

Figure 3

Intraoperative findings in a 54-day-old child: (a) Gangrenous bowel loops seen on laparotomy (b) Mid ileal mesenteric defect with around 70 cm of ileal gangrene