横行結腸間膜裂孔ヘルニアの１例

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  • A Case of Transmesocolonic Hernia in the Mesentery of Transverse Colon

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We report a rare case of transmesocolonic hernia in the mesentery of the transverse colon due to internal hernia. A 81-year-old man, with no history of surgery but twice admitted previously with a diagnosis of ileus, reported abdominal pain, abdominal distention, and vomiting. Under a diagnosis of ileus, we conducted conservative long-tube therapy. Complications were arose when the tube passed through the Treitz ligament, stagnated in the left upper abdomen, and failed to relieve intestinal dilatation, nessecitating surgery 24 days after admission. Laparotomy showed an oval defect about 4 cm in diameter in the mesentery of the transverse colon, and most of the small intestine had invaginated through the defect into the omental cavity. The small intestine was reverted by manipulation and had no necrosis, so the defect was repaired by suture. The postoperative course was uneventful. Transmesocolonic heria is rare, but should be considered a differential diagnosis of ileus with no history of surgery.

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