Intramesenteric internal hernia with midgut volvulus: a rare case causing small bowel gangrene in an adult

Authors

  • S. N. Pravindhira Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India http://orcid.org/0000-0002-7624-5114
  • R. Kannan Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
  • P. Prabhakar Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20210948

Keywords:

Internal hernia, Intramesenteric hernia, Small bowel mesentery related hernia, Volvulus, Bowel gangrene

Abstract

Intramesenteric internal hernia is a rare type of small bowel mesentery related internal hernia which usually occur in pediatric population. It is characterized by herniation of small bowel loops through a congenital or acquired defect in one layer of the mesentery producing a mesenteric pouch type hernia. The defect usually occurs near the ileocaecal valve or ligament of treitz and the herniated bowel loops are prone to strangulation or volvulus, presenting as small bowel obstruction that warrants early recognition and emergency laparotomy to confirm the diagnosis and prevent bowel gangrene and its complication. We present a case of 59 year old male presenting with features of an acute intestinal obstruction since morning and a vague firm mass in the right upper quadrant which was confirmed by CT scan to be an internal hernia and patient was taken up for emergency laparotomy. Intraoperative findings revealed a sac of small bowel loops herniating into the mesentery through a defect near the terminal ileum. Upon reducing the contents a volvulus was evident and resulted in the gangrene of the small bowel loops. The gangrenous bowel was resected and a single layered end to end ileo-ileal anastamosis was done. The diagnosis of internal hernia in a adult with no previous history of abdominal surgery or trauma is a very rare entity and requires a high degree of suspicion and close monitoring of the patient to ensure early surgical intervention and optimal outcome.

 

Author Biographies

S. N. Pravindhira, Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Surgery resident,

Institue of General Surgery,

Madras Medical College

R. Kannan, Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Director,

Institute of General Surgery

Madras Medical College

P. Prabhakar, Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Assistant Professor,

Institute of General Surgery,

Madras Medical College.

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Published

2021-02-25

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Section

Case Reports