A Case of Transmesosigmoid Hernia

DOI 3 Citations 11 References

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  • S状結腸間膜裂孔ヘルニアの1例

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Abstract

The patient was an 81-year-old woman. She consulted a local clinic complaining of acute lower abdominal pain and was referred to our hospital after being diagnosed as having ileus. Upon examination, rebound tenderness was noted in the lower abdomen but muscle guarding was not observed. A plain abdominal X-ray showed the absence of gas. Contrast-enhanced computed tomography (CT) of the abdomen revealed marked retention of ascites and dilatation of the small intestine with the concentrated mesentery in the lower abdomen. These findings suggested strangulation ileus, and an emergency surgery was performed 15 hours after onset. A laparotomy revealed an oval defect 5 cm in diameter in the sigmoid mesocolon. Approximately 60 cm of the small intestine had herniated through the defect at a point 100 cm distant from Treitz's ligament and had been strangulated. Under a diagnosis of transmesosigmoid hernia-related strangulation ileus, the necrotic intestine was resected and the oval defect was closed. Transmesosigmoid hernia is rare and may be difficult to diagnose prior to surgery. However, this disease should be considered when ileus of unknown cause is encountered so that strangulation ileus can be diagnosed at an early stage.

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