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Case Reports
. 2025 Jan 7;2025(1):rjae834.
doi: 10.1093/jscr/rjae834. eCollection 2025 Jan.

Persistent ascending mesocolon: an unexpected content in a giant and complex paraumbilical hernia of a 48-year-old obese woman

Nuhu N Naabo  1   2 , Raymond S Maalman  3 , Aishah F Adamu  3 , Mohammed N Naabo  4 , Samuel Mensah  5
Affiliations
Case Reports

Persistent ascending mesocolon: an unexpected content in a giant and complex paraumbilical hernia of a 48-year-old obese woman

Nuhu N Naabo et al. J Surg Case Rep. .

Abstract

Persistent ascending mesocolon (PAM) is a rare congenital anomaly in ⁓2%-4% of individuals. PAM is associated with various complications, including volvulus of the colon and caecum, bowel perforation, intestinal obstruction, and adhesions. This case is reported on a 48-year-old woman who reported to the Ho Teaching Hospital specialist clinic with a 13-year history of initial painless and reducible paraumbilical swelling. Management was based on a surgical approach. The content of the hernia sac was unusual with a viable appendix, caecum, ascending and transverse colons inclusive, and ascending mesocolon was persistent. The repair was done through an anterior component separation technique. An onlay mesh repair was fashioned with a 30 cm × 30 cm polypropylene mesh. This case report highlights the complexities of managing a giant paraumbilical hernia in a morbidly obese patient with a PAM, a rare congenital anomaly.

Keywords: appendix; colon; obese; paraumbilical hernia; persistent ascending mesocolon.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Showing the anterior (a) and lateral (b) views of the preoperative state of the woman.
Figure 2
Figure 2
Showing (a) the incision unveiling the content covered with the sac; (b) the hernia sac; (c) the appendix (Blue arrow), PAM and colon (arrow head) continuing with the transverse colon; and (d) excessive fat on the mesentery.
Figure 3
Figure 3
Showing the onlay 30 × 30 cm polypropylene mesh in-situ.
See this image and copyright information in PMC

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