Intestinal obstruction in a patient with congenital transverse mesocolic defect with internal hernia: A case report.

Introduction And Importance: Internal hernias (IH) account for 5.8 % of all cases of intestinal obstruction. Intestinal obstruction due to congenital transverse mesocolic defects is a rare but significant clinical challenge that requires prompt recognition and surgical intervention.

Case Discussion: A 71-year-old female with COPD presented with acute abdominal pain, abdominal distension, and vomiting. On physical examination, the abdomen was distended with generalized tenderness. Contrast-enhanced computed tomography (CECT) revealed a transition point at the ileum. Failure of conservative management led to exploratory laparotomy that revealed a 7 cm ∗ 6 cm defect in the transverse mesocolon with herniation of ileal loops into the lesser sac. The hernia was reduced, and the defect closed. Postoperatively, the patient recovered well without complications.

Clinical Discussion: IH, including transverse mesocolic IH (TMIH), are often asymptomatic or present with vague abdominal pain. They are challenging to diagnose clinically and radiologically. It has been reported in several studies, with internal hernias due to mesocolic defects accounting for about 0.2-0.9 % of all abdominal hernias. CECT offers a diagnostic accuracy of 77 %. Surgical intervention is necessary for complicated cases, with a focus on reducing the herniated bowel and closing the defect. This case highlights the importance of considering congenital mesocolic defects in the differential diagnosis of unexplained intestinal obstruction, particularly in elderly patients.

Conclusion: Congenital TMIH should be considered in the differential diagnosis of patients with unexplained bowel obstruction, especially when the clinical picture is atypical. Early diagnosis with imaging and surgical repair leads to favorable outcomes, as demonstrated in this case.