Bakry Husham, Sivagnanam Prabu Shankar, Hamad Omar
General Surgery, King Hamad University Hospital, Bahrain Defence Force Royal Medical Services, Busaiteen, BHR.
Medicine and Surgery, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, BHR.
Cureus. 2025 Jul 29;17(7):e89013. doi: 10.7759/cureus.89013. eCollection 2025 Jul.
Internal hernias are one of the rare causes of small bowel obstruction. Among them, transmesocolic hernias are particularly uncommon and pose a diagnostic challenge due to their non-specific clinical and radiological features. We report the case of a 68-year-old female with known metastatic invasive lobular carcinoma of the breast, who presented with right flank pain, nausea, and constipation. Imaging suggested small bowel obstruction without a clear etiology. Emergency laparotomy revealed a transmesocolic hernia with two jejunal loops herniated through a 6 cm × 3 cm mesocolic defect. The herniated bowel was viable and reduced, and the defect was repaired. No bowel resection was necessary. Transmesocolic hernias may be congenital or acquired. In this case, the defect was likely secondary to peritoneal carcinomatosis or mass effect from metastatic disease. Diagnosis is often delayed due to non-specific signs. Early surgical intervention is essential to prevent bowel ischemia and infarction. Transmesocolic hernia, though rare, should be considered in patients with small bowel obstruction and no prior surgical history, especially in the setting of peritoneal malignancy. High clinical suspicion and timely operative management are critical for favorable outcomes.
内疝是小肠梗阻的罕见原因之一。其中，经结肠系膜疝尤为罕见，因其临床和影像学表现不具特异性，故诊断颇具挑战。我们报告一例68岁女性病例，该患者已知患有转移性乳腺浸润性小叶癌，表现为右侧胁腹疼痛、恶心和便秘。影像学检查提示小肠梗阻，但病因不明。急诊剖腹探查发现一个经结肠系膜疝，两个空肠袢经一个6厘米×3厘米的结肠系膜缺损处疝出。疝入的肠管存活并还纳，缺损处得以修复。无需进行肠切除。经结肠系膜疝可能是先天性的，也可能是后天获得性的。在本病例中，缺损可能继发于腹膜癌病或转移性疾病的占位效应。由于体征不具特异性，诊断往往延迟。早期手术干预对于预防肠缺血和梗死至关重要。经结肠系膜疝虽罕见，但对于无既往手术史的小肠梗阻患者，尤其是在存在腹膜恶性肿瘤的情况下，应予以考虑。高度的临床怀疑和及时的手术治疗对于取得良好预后至关重要。
