Congenital transmesenteric internal hernia causing acute abdomen: A case report

Introduction: Internal herniation through a congenital mesenteric defect is an exceptional cause of acute intestinal obstruction. It is usually diagnosed during surgery. We report a case of congenital transmesenteric internal hernia in a 7-year-old girl, without an acute intestinal obstruction syndrome.Case presentation: A 7-year-old girl with no previous medical history was admitted to our unit for sudden severe abdominal pain. No vomiting, no signs of trauma or infection. She was in good general condition. Physical examination showed slight abdominal distension, extensive pain and tenderness on palpation. Rectal examination revealed normal stools and no blood No evidence of an inflammatory response. Abdominal ultrasound revealed moderate ascites and no signs of ischemic bowel. After resuscitation, the child was taken to the operating room for emergency laparotomy. Under general anaesthesia, a median incision was performed. Exploration revealed an extensive ileal necrosis and a small bowel incarceration through a mesenteric defect with a narrow opening. Resection and end-to-end ileo-ileal anastomosis was performed. The remainder jejuno-ileal segment was approximately 200 cm long. At 6 months postoperatively, the child had gained weight steadily. No symptoms of short small bowel syndrome.Conclusion: Congenital internal transmesenteric hernia should be considered in cases of sharp abdominal pain in young children, even without signs of intestinal obstruction syndrome.