Traumatic transmesenteric hernia leading to ischemic enterocolitis in an adolescent - case report

Abstract

Introduction and importance: Traumatic transmesenteric hernia (TTMH) is an exceptionally rare condition with high morbidity and mortality, particularly in children. It can cause life-threatening complications such as ischemic enterocolitis. Internal hernias, including transmesenteric types, are difficult to diagnose preoperatively and are often discovered during emergency laparotomy.

Case presentation: A 13-year-old girl presented with acute abdominal pain, bilious vomiting, and hypovolemic shock. She had sustained blunt abdominal trauma from a fall two weeks earlier. Initial resuscitation and imaging raised concerns for acute intestinal obstruction. Due to clinical deterioration, an emergency exploratory laparotomy was performed, revealing a transmesenteric hernia with 120 cm of ischemic ileum. Bowel resection and a double-barrel ileostomy were performed. Histopathology confirmed ischemic enterocolitis secondary to the hernia. The patient recovered well and later underwent successful ileostomy reversal.

Discussion: Transmesenteric hernias are rare, typically congenital or post-surgical, with traumatic cases being extremely uncommon. Diagnosis is challenging due to a lack of specific clinical findings. Delayed intervention increases the risk of bowel ischemia and mortality.

Conclusion: This case highlights the diagnostic difficulty of TTMH and emphasizes the need for a high index of suspicion in trauma patients presenting with acute abdomen. Educating patients with trauma about warning signs & follow up is the recommendation.

Keywords: Acute intestinal obstruction; Exploratory laparotomy; Internal hernia; Ischemic enterocolitis; Pediatric emergency; Traumatic transmesenteric hernia.

Fig. 1

Abdominal X-ray showing central multiple air-fluid levels.

Fig. 2

Single slide from contrast-enhanced CT scan, with marked lesions showing ascites and bowel distension.

Fig. 3

Per-operative finding of gangrenous bowel.

Fig. 4

Mesenteric defect after resection of gangrenous bowel.