The Rare Middle Mesocolic Hernia

Due to significant abdominal pain and persistent tachycardia despite aggressive fluid resuscitation in the emergency room, the patient was taken urgently to the OR for diagnostic laparoscopy, which revealed an inferiorly displaced transverse colon with diffuse small bowel dilation. Most patients pre...

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Bibliographic Details
Published in:The American surgeon 2022-06, Vol.88 (6), p.1346-1348
Main Authors: Montovano, Margaret, Chernock, Brad, Merchant, Aziz M., Shapiro, Michael, Oliver, Joseph B.
Format: Article
Language:English
Subjects:
Abdomen
Abdominal surgery
Adhesives
Cardiac arrhythmia
Case reports
Colon
Congenital diseases
Constipation
Digestive System Abnormalities
Dyspepsia
Emergency medical care
Emergency medical services
Hernia
Hernia - diagnostic imaging
Hernias
Humans
Laboratories
Laparoscopy
Laparotomy
Mesentery
Mesocolon - surgery
Pain
Pancreas
Patients
Peritoneal Diseases
Resuscitation
Small intestine
Tachycardia
Vomiting
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Summary:Due to significant abdominal pain and persistent tachycardia despite aggressive fluid resuscitation in the emergency room, the patient was taken urgently to the OR for diagnostic laparoscopy, which revealed an inferiorly displaced transverse colon with diffuse small bowel dilation. Most patients present between the fourth and sixth decades of life with symptoms of SBO. 2 In a significant number of patients, however, a history of chronic symptoms such as dyspepsia, vomiting, and intermittently colicky abdominal pain have been reported. 2 Similar to our cases, 3 previous case reports describing middle mesocolic hernias presented as SBO in adult patients with similar nonspecific clinical and radiologic findings2-4 and 2 with bowel strangulation necessitating resection.3,4 Because of their nonspecific presentation, imaging is important in order to expeditiously diagnose and treat congenital mesocolic hernias. Radiographic evidence of an inferiorly displaced transverse colon with clustered loops of small bowel between the stomach and pancreas in the setting of SBO should prompt urgent surgical exploration rather than conservative management.
ISSN:0003-1348
1555-9823
DOI:10.1177/0003134820945278