Strangulated transmesosigmoid hernia as a late complication of a fall from a height: A case report. (2016)

• Record Type: Journal Article
• Authors: Kojima, Shigehiro; Sakamoto, Tsuguo; Honda, Masayuki; Kim, Dal Ho
• Is Part Of: International journal of surgery case reports. Volume 27(2016)
• Page Start: 137
• Page End: 140
• Publication Date: 2016
• Subjects: Abdominal blunt trauma -- Case report -- Internal hernia -- Intestinal obstruction -- Laparoscopic herniorrhaphy -- Sigmoid mesocolon hernia; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2016.08.031
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: A transmesosigmoid hernia in a patient with a history of a fall from a height. Abdominal blunt trauma can cause a transmesosigmoid hernia. A transmesosigmoid hernia should be considered in patients with an internal hernia. Laparoscopic management help simultaneous diagnosis and surgical intervention. Abstract: Introduction: A transmesosigmoid hernia is defined as small bowel herniation through a complete defect involving both layers of the sigmoid mesentery. Blunt trauma injury to the sigmoid mesocolon has been reported only rarely. We herein report a case of a strangulated transmesosigmoid hernia associated with a history of a fall from a height. Presentation of case: A 43-year-old woman presented to our hospital for evaluation of vomiting. She had no history of abdominal surgery but had sustained a complete spinal cord injury and pelvic fracture secondary to a fall from a height 25 years earlier. A computed tomography scan of her abdomen and pelvis demonstrated a closed loop of small bowel in the pelvis, with a zone of transition in the left lower abdomen. Although the cause of the obstruction was difficult to establish, ischemia was strongly suspected; therefore, the decision was made to perform emergency exploratory laparoscopy. During laparoscopy, a loop of ileum was observed to have herniated through a full-thickness defect in the sigmoid mesocolon, consistent with a transmesosigmoid hernia. The herniated loop was strangulated but not gangrenous and was successfully reduced using laparoscopic graspers. The incarcerated small bowel appeared viable and was therefore not resected. The defect was closed with a running suture. The patient had an uneventful postoperative course with no recurrence. Discussion and conclusion: Abdominal blunt trauma can cause sigmoid mesenteric rupture resulting in a transmesosigmoid hernia. In the management of transmesosigmoid hernias, laparoscopic herniorrhaphy has the advantage of facilitating simultaneous diagnosis and surgical intervention.