A mesenteric defect causing internal herniation and ischaemia of both the ascending and sigmoid colons, treated with a bowel preserving surgery

Internal hernias due to mesenteric defects are a rare cause of bowel obstruction, but once present their complications are associated with a high morbidity and mortality. We present the case of a 24-year-old patient who presented to the emergency department with a 6-hour history of abdominal pain. I...

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Bibliographic Details
Published in:BMJ case reports 2021-06, Vol.14 (6), p.e242031
Main Authors: Al-Saadi, Nina, Devani, Pooja, Hunter, David I, Bowrey, David J
Format: Article
Language:English
Subjects:
Abdomen
Adult
Case Report
Case reports
Colon
Colon, Sigmoid - diagnostic imaging
Colon, Sigmoid - surgery
Hernia, Abdominal - diagnostic imaging
Hernia, Abdominal - surgery
Hernias
Humans
Intestinal obstruction
Intestinal Obstruction - diagnostic imaging
Intestinal Obstruction - etiology
Intestinal Obstruction - surgery
Ischemia
Ischemia - diagnostic imaging
Ischemia - etiology
Ischemia - surgery
Mesentery
Mesentery - diagnostic imaging
Mesentery - surgery
Mortality
Ostomy
Pain
Patients
Surgery
Young Adult
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Summary:Internal hernias due to mesenteric defects are a rare cause of bowel obstruction, but once present their complications are associated with a high morbidity and mortality. We present the case of a 24-year-old patient who presented to the emergency department with a 6-hour history of abdominal pain. Initial surgical review, taking into consideration the patient’s clinical, biochemical and radiological findings, led to the patient being taken for immediate surgical exploration. Operative findings included a very mobile caecum and proximal ascending colon which had herniated through a defect in the small bowel mesentery, the sigmoid colon had subsequently become incarcerated by the caecum and small bowel too. Both the ascending and sigmoid colon had become ischaemic. Due to the early decision for surgical intervention, we were able to consider a number of surgical strategies, and the surgery led to a positive outcome for our patient.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-242031