A RARE CASE OF TRANSMESOCOLIC HERNIATION OF SMALL BOWELTHROUGH A CONGENITAL DEFECT PRESENTING AS A CLOSED BOWEL OBSTRUCTION - A CASE REPORT AND LITERATURE REVIEW OF REPAIRS OF INTERNAL HERNIAS

Transmesocolic hernia is an uncommon type of Internal hernia with incidence ranging from approximately 5–10% of all Internal Hernias. To the best of our knowledge, this is the first reported case of a transmesocolic hernia in adults without any surgical history or trauma. Small bowel loops were found herniating into the supracolic compartment through a congenital defect in transverse mesocolon presenting clinically as Small Bowel obstruction. A 20-year-old man was admitted with clinical features of intestinal obstruction. An abdominal X-ray showed multiple small bowel loops with air fluid levels. Contrast-enhanced CT of the abdomen revealed small bowel obstruction not only on the right, but also on the left side of the collapsed descending colon. Emergency Exploratory Laprotomy was performedand bowel loops with discolouration seen enclosed in hernial sac in supracolic compartment which were milked out of defect and observed to have obtained vascularity almost immediately. The postoperative period was uneventful. Preoperative diagnosis of bowel obstruction caused by a transmesocolic hernia remains difficult despite the currently available imaging techniques. Prompt surgery can prevent serious complications such as Bowel gangrene, peritonitis and sepsis.