Shabhay Ahmed Ali, Shabhay Zarina Ali, Mwami Amri Salim, Msuya David, Chilonga Kondo, Massaga Fabian Anaclet
Military Hospital Mwanza, P.O. Box 589, Mwanza, Tanzania.
Muhimbili Orthopedic Institute (MOI), P.O. Box 65474, Dar es Salaam, Tanzania.
Int J Surg Case Rep. 2024 Nov;124:110355. doi: 10.1016/j.ijscr.2024.110355. Epub 2024 Sep 26.
Spontaneous trans-mesenteric hernia is a rare entity in adults. Its pre-operative diagnosis is challenging even with Computed Tomography Scanning. Most cases are diagnosed as incidental findings during laparotomy or postmortem. This case report highlights that even in geriatric patients without prior laparotomies, peritonitis or abdominal trauma which predispose to trans-mesenteric herniation, a differential diagnosis of a spontaneous trans-mesenteric hernia is of paramount importance as delay in diagnosis leads to death.
We report a case of a geriatric lady who presented with features of intestinal obstruction. Intra-operative findings revealed strangulated gangrenous small bowels extending from 170 cm from ligament of Treitz to the ileal caecal junction through a trans-mesenteric defect of about 12 cm in diameter. She underwent resection of the gangrenous small bowel with right hemi colectomy and jejunal-transverse colon end to side anastomosis. However, she succumbed two days post operatively.
Spontaneous trans-mesenteric hernia is a rare cause of small bowel obstruction in adults, difficult to clinically and radiologically diagnose pre-operatively and mostly presents with bowel ischaemia due to strangulation. Early diagnosis is paramount in reducing morbidity and mortality rates in these cases.
Delay in diagnosis of trans-mesenteric hernia leads to strangulation, gangrene of bowels and eventual death. A high index of suspicion is needed from both surgeons and radiologists even in cases of intestinal obstruction without prior histories of laparotomy, peritonitis or abdominal trauma.
自发性肠系膜疝在成人中是一种罕见疾病。即使采用计算机断层扫描，其术前诊断也具有挑战性。大多数病例是在剖腹手术或尸检时作为偶然发现而被诊断出来的。本病例报告强调，即使在没有先前剖腹手术、腹膜炎或腹部创伤等易引发肠系膜疝的老年患者中，对自发性肠系膜疝进行鉴别诊断也至关重要，因为诊断延迟会导致死亡。
我们报告一例老年女性患者，其表现为肠梗阻症状。术中发现绞窄性坏疽的小肠，从屈氏韧带170厘米处延伸至回盲部，通过一个直径约12厘米的肠系膜缺损处。她接受了坏疽小肠切除术、右半结肠切除术以及空肠 - 横结肠端侧吻合术。然而，她在术后两天死亡。
自发性肠系膜疝是成人小肠梗阻的罕见原因，术前在临床和影像学上难以诊断，且大多因绞窄而出现肠缺血。在这些病例中，早期诊断对于降低发病率和死亡率至关重要。
肠系膜疝诊断延迟会导致绞窄、肠坏疽并最终死亡。即使在没有先前剖腹手术、腹膜炎或腹部创伤病史的肠梗阻病例中，外科医生和放射科医生也需要高度怀疑。
