de Jesús González-Luna Antonio, Álvarez-Gutierrez Jaime Antonio, Cruz-Bonilla Natalia, Juárez-Mora Matthew Abel, Torres-Salazar Quitzia Libertad
Regional Hospital "Dr. Valentín Gómez Farías", Institute of Security and Social Services for State Workers, Mexico.
Autonomous University of Guadalajara, Mexico.
Int J Surg Case Rep. 2024 Oct;123:110189. doi: 10.1016/j.ijscr.2024.110189. Epub 2024 Aug 22.
Congenital transmesenteric hernia is a rare form of hernia and intestinal obstruction. Autopsy studies report an incidence of 0.2-0.9 % of internal hernias, causing intestinal obstruction in 4.1 % of all cases.
A 35-year-old female patient, with no surgical history, presented with severe abdominal pain in the right hemiabdomen, nausea, and vomiting. She was initially unsuccessfully treated for gastritis. Upon admission to our unit, she had stable vital signs but severe abdominal pain. An acute abdomen was diagnosed, and a diagnostic laparoscopy converted to open surgery revealed an internal transmesenteric hernia with partial intestinal obstruction. A right hemicolectomy with ileotransverse anastomosis was performed.
Diagnosing this condition is challenging due to nonspecific symptoms and signs, and radiological investigations may not provide sufficient information. The clinical features of a transmesenteric hernia can mimic more common causes of acute abdominal pain, such as appendicitis, complicating early identification. Computed tomography (CT) is the most useful imaging modality, but even with CT, the diagnosis can be difficult due to the rarity of the condition and the lack of specific signs.
Early intervention and surgical correction in this case were crucial to preventing mortality associated with internal hernias.
Level IV.
先天性肠系膜裂孔疝是一种罕见的疝和肠梗阻类型。尸检研究报告显示，内疝的发生率为0.2 - 0.9%，在所有病例中导致肠梗阻的占4.1%。
一名35岁女性患者，无手术史，出现右半腹严重腹痛、恶心和呕吐症状。她最初因胃炎接受治疗但未成功。入院时，她生命体征稳定，但腹痛严重。诊断为急腹症，诊断性腹腔镜检查转为开放手术后发现肠系膜内疝伴部分肠梗阻。进行了右半结肠切除术加回肠横结肠吻合术。
由于症状和体征不具特异性，诊断这种疾病具有挑战性，放射学检查可能无法提供足够信息。肠系膜裂孔疝的临床特征可能类似于急性腹痛的更常见原因，如阑尾炎，这使得早期识别变得复杂。计算机断层扫描（CT）是最有用的成像方式，但即使使用CT，由于该疾病罕见且缺乏特异性体征，诊断仍可能困难。
在这种情况下，早期干预和手术矫正对于预防与内疝相关的死亡至关重要。
四级。
