Transmesenteric Internal Hernia: A Case Report

Abstract

Transmesenteric internal hernias are a rare cause of small bowel obstruction and are most frequently described in pediatric patients. Their occurrence in adults, particularly in the elderly, is exceptional and often associated with diagnostic difficulty because of non-specific clinical and radiological findings. We report the case of an 80-year-old man with no previous medical or surgical history who presented with acute diffuse abdominal pain associated with vomiting and obstipation. Imaging findings suggested small bowel obstruction without a clearly identified etiology. Emergency surgical exploration revealed a congenital transmesenteric defect of the terminal ileum with incarceration of a small bowel loop. The herniated bowel was congested but viable, allowing reduction without intestinal resection, and the mesenteric defect was closed with interrupted sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day two. Congenital transmesenteric internal hernia should be considered in cases of unexplained small bowel obstruction in patients without prior abdominal surgery, and early surgical management is crucial to prevent bowel ischemia and ensure favourable outcomes.