Journal List > Korean J Gastroenterol > v.53(5) > 1006550

Park, Kim, Choi, and Kim: A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect

Abstract

Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.

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Fig. 1.
Plain erect abdominal X-ray showed multiple dilated loops of the small bowel.
kjg-53-320f1.tif
Fig. 2.
Abdominal CT scan showed bulky amount of ischemic small bowel loops and ascites in the abdominal cavity.
kjg-53-320f2.tif
Fig. 3.
Intraoperative findings. (A) Long segment of the strangulated ileum was gangrenous and normal appearing loops of the jejunum were dilated. (B) After reduction, a large round mesenteric defect near the terminal ileum with gangrenous loops of the entire ileum was seen.
kjg-53-320f3.tif
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