113 Exploratory laparoscopy in suspected bowel obstruction secondary to a transmesenteric hernia
Beatriz Carrasco Aguilera, Miguel Martinez-Cachero García, Pablo del Val Ruiz, Andres Cembellin Prieto, Jose Luis Rodicio Miravalles, Jose Electo Granero Trancón- Surgery
Abstract
Background
Transmesenteric hernias (TH) in adults are an uncommon subtype of internal hernia that can be life-threatening because of the risk of bowel ischemia if not correctly diagnosed.
Case report
A 79-year-old man came to the emergency department with abdominal pain associated with vomiting and constipation for 24 hours. Physical examination showed no alarm signs. However, due to the presence of leukocytosis with neutrophilia and an abdominal X-ray with suspected obstruction, an abdominal CT scan was requested. Given the radiological finding of a defect in the mesentery through which a portion of the mesentery and several loops of bowel were introduced, an exploratory laparoscopy was indicated on suspicion of TH. Intraoperatively, 150 cm from the ileocecal valve, a 30 cm congestive segment of jejunum was observed, which was inserted in a 4 cm long eyelet in the omentum. Reduction of the herniated small bowel loops through the eyelet was performed without difficulty, observing good viability of the loops, and the eyelet was opened with scissors leaving the omentum open at the distal end. The patient was discharged on the 5th postoperative day tolerating oral diet, with transit and the surgical wound without signs of infection.
Conclusion
Although CT is the best diagnostic test for TH its preoperative diagnosis remains difficult. In the case of suspected TH, early exploratory laparoscopy is a correct technique that can preserve the viability of the bowel.