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Case Report
 
Transmesosigmoid hernia with small bowel strangulation
Ji Won Kim1, Dae Hyun Yang2
1Fellow Surgeon, Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
2Professor, Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

doi:10.5348/ijcri-2012-12-232-CR-6

Address correspondence to:
Dae Hyun Yang
MD 948-1, Daerim 1-dong
Yeongdeungpo-gu
Seoul, 150-950
Korea
Phone: 82-2-829-5130
Fax: 82-2-834-6526
Email: Kimjiw96@naver.com

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How to cite this article:
Kim JW, Yang DH. Transmesosigmoid hernia with small bowel strangulation. International Journal of Case Reports and Images 2012;3(12):25–28.


Abstract
Introduction: Internal herniation of the small bowel is difficult to diagnose before surgery. Delayed laparotomy is related to high morbidity and mortality. We present a rare case of a transmesosigmoid hernia to demonstrate the importance of high suspicion and early laparotomy.
Case Report: A 44-year-old female patient had severe abdominal pain of acute onset. A CT scan at six hours after onset of the symptoms showed a dilated small bowel loop of diminished attenuation. Her severe pain was not controlled even with narcotics. An emergency laparotomy eight hours after onset revealed about a 150 cm strangulated closed loop of the mid small intestine, herniated through a small mesenteric defect of the sigmoid colon. The defect in the mesosigmoid was about three cm in diameter without a sac, and functioned similarly to a napkin ring; therefore the reduction of the herniated closed intestine loop was difficult without division of the intestine. The patient recovered well after resection anastomosis and closure of the mesenteric defect.
Conclusion: Congenital internal hernia is rare, but early development of incarceration and strangulation is associated with increased morbidity and mortality. Early suspicion and urgent or emergent laparotomy or laparoscopic exploration and surgical management are necessary.

Keywords: Transmesenteric hernia, Sigmoid colon, Internal hernia, Transmesosigmoid hernia


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Author Contributions
Ji Won Kim – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Dae Hyun Yang – Conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© Ji Won Kim et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)