• Hernia, Abdominal/diagnostic imaging
• Hernia, Abdominal/surgery
• Humans
• Internal Hernia
• Laparoscopy
• Mesocolon

Patient: Male, 51-year-old

Final Diagnosis: Congenial dual internal hernia with small bowel obstruction

Symptoms: Abdominal pain • vomiting • constipation

Medication: —

Clinical Procedure: —

Specialty: Surgery

• acute small bowel obstruction
• cholestasis syndrome
• coagulopathy
• liver failure
• multiple organ failure
• peritonitis

• Acute Disease
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/mortality
• Intestine, Small
• Liver Failure/diagnosis
• Liver Failure/etiology
• Liver Failure/mortality
• Multiple Organ Failure/diagnosis
• Multiple Organ Failure/etiology
• Multiple Organ Failure/mortality
• Peritonitis/etiology
• Peritonitis/mortality

Introduction. Internal hernias are often misdiagnosed because of their rarity, with subsequent significant morbidity. Case Presentation. A 61-year-old Japanese man with no history of surgery was referred for intermittent abdominal pain. CT suggested the presence of a transmesocolic internal hernia. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We found internal herniation of the small intestine loop through a defect in the transverse mesocolon, without any strangulation of the small intestine. We were able to complete the operation laparoscopically. The patient's postoperative course was uneventful and the patient was discharged on postoperative day 6. Discussion. Transmesocolic hernia of the transverse colon is very rare. Transmesocolic hernia of the sigmoid colon accounts for 60% of all other mesocolic hernias. Paraduodenal hernias are difficult to distinguish from internal mesocolic transverse hernias. We can rule out paraduodenal hernias with CT. Conclusion. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We report a case of a transmesocolic hernia of the transverse colon with intestinal obstruction that was diagnosed preoperatively and for which laparoscopic surgery was performed.

Transmesosigmoid hernia has previously been considered as a rare condition. The clinical symptoms can be nonspecific. Here, we report a case of acute intestinal obstruction because of transmesosigmoid hernia. In addition, after a comprehensive review of PubMed and China National Knowledge Infrastructure, we present a review of 22 cases of transmesosigmoid hernia. We summarize several valuable clinical features that help early recognition of transmesosigmoid hernia. As a result of easy strangulation, in patients without a history of surgery or abdominal inflammation who present with symptoms of progressive or persistent small bowel obstruction (SBO), surgeons should consider the possibility of transmesosigmoid hernia. In addition, based on our data, in patients with SBO because of transmesosigmoid hernia, the defect is usually 2-5 cm in diameter. Furthermore, because of the high risk of strangulation with transmesosigmoid hernia, it is mandatory to reassess the condition timely and periodically when patients receive conservative treatment.

• Transmesosigmoid hernia
• Acute intestinal obstruction
• Internal hernia

• Abdominal Pain/diagnosis
• Disease Progression
• Hernia/complications
• Herniorrhaphy
• Humans
• Inflammation
• Intestinal Obstruction/etiology
• Laparotomy
• Male
• Middle Aged
• Radiography, Abdominal
• Tissue Adhesions
• Tomography, X-Ray Computed
• Treatment Outcome

Internal hernia is an unusual cause of small bowel obstruction and classified several types according to locations. Sigmoid mesocolic hernia is an uncommon condition and among others intramesosigmoid hernia was rarely reported in the literature. We report the case of a 49-year-old female with a rare type of congenital internal hernia, through the mesosigmoid, causing small bowel obstruction. She suffered from obstructive symptoms but with no previous history of laparotomy. The diagnosis of internal hernia was suggested by computed tomography, but the type of internal hernia was confirmed by laparoscopic exploration. She underwent laparoscopic detachment of peritoneal attachment comprising hernia sac without defect repair. The postoperative course was uneventful and the patient is free from symptoms and recurrence. This report presents a case of intrasigmoid hernia managed successfully by the laparoscopic approach and shows another surgical technique according to hernia types.