Horiuchi Yuki, Nishimura Erica, Sashi Eriko, Matsuo Kazuhiro, Watanobe Nozomi, Ohtani Risa, Matsunami Koshiro, Muroi Takako, Hara Asuka, Hayashi Keita, Tajima Yuki, Kaneko Yasushi, Hamanaka Rurika, Fujisaki Hiroto, Hongo Kumiko, Yo Kikuo, Yoneyama Kimiyasu, Takano Kiminori, Nakagawa Motohito
Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-Shi, Kanagawa, 254-0065, Japan.
Surg Case Rep. 2024 Oct 28;10(1):246. doi: 10.1186/s40792-024-02040-3.
Small mesenteric hiatal hernias (SMHHs) are defined as a small group of internal hernias (IHs) that frequently diagnosed in children. However, SMHHs are relatively rare in adults. Bowel loop herniation via an abnormal mesenteric defect can lead to strangulated intestinal obstruction. Congenital SMHHs are commonly observed in pediatric patients, with some cases involving neonatal death.
A 24-year-old healthy male patient visited our hospital with a 2-day history of a sudden onset lower abdominal pain. He was initially diagnosed with enteritis. However, his symptoms worsened, and he was brought to our hospital. Contrast-enhanced computed tomography (CT) scan showed formation of a closed loop in the small intestine within the pelvis and signs of ischemia. As the patient was diagnosed with small bowel obstruction (SBO) caused by IH, emergency laparoscopic surgery was performed to loosen the obstruction. The patient was found to have ascites and small-bowel necrosis. A part of the small intestine that measured 30 cm was strangulated via a large-diameter defect (17 × 11 cm) in the ileal mesentery. Via a small abdominal incision, the necrotic bowel was resected, and the mesenteric defect was repaired.
SMHHs are rare in adults, and they should be considered as potential causes of strangulated intestinal obstruction in adults without a history of laparotomy or trauma.
小肠系膜裂孔疝（SMHHs）是一组常发生于儿童的内疝（IHs）。然而，SMHHs在成人中相对少见。肠袢通过异常的系膜缺损疝出可导致绞窄性肠梗阻。先天性SMHHs常见于儿科患者，部分病例可导致新生儿死亡。
一名24岁健康男性患者因突发下腹痛2天前来我院就诊。他最初被诊断为肠炎。然而，他的症状加重，随后被送往我院。增强计算机断层扫描（CT）显示盆腔内小肠形成闭袢及缺血迹象。由于该患者被诊断为内疝导致的小肠梗阻（SBO），遂行急诊腹腔镜手术以解除梗阻。术中发现患者有腹水及小肠坏死。一段30厘米长的小肠通过回肠系膜上一个大直径缺损（17×11厘米）发生绞窄。经腹部小切口切除坏死肠段，并修复系膜缺损。
SMHHs在成人中罕见，对于无剖腹手术或外伤史的成人绞窄性肠梗阻患者，应考虑到SMHHs这一潜在病因。
