Congenital transmesenteric hernia: A rare case in adults

Introduction and importance: Congenital transmesenteric hernia is a rare form of hernia and intestinal obstruction. Autopsy studies report an incidence of 0.2-0.9 % of internal hernias, causing intestinal obstruction in 4.1 % of all cases. Case presentation: A 35-year-old female patient, with no surgical history, presented with severe abdominal pain in the right hemiabdomen, nausea, and vomiting. She was initially unsuccessfully treated for gastritis. Upon admission to our unit, she had stable vital signs but severe abdominal pain. An acute abdomen was diagnosed, and a diagnostic laparoscopy converted to open surgery revealed an internal transmesenteric hernia with partial intestinal obstruction. A right hemicolectomy with ileotransverse anastomosis was performed. Clinical discussion: Diagnosing this condition is challenging due to nonspecific symptoms and signs, and radiological investigations may not provide sufficient information. The clinical features of a transmesenteric hernia can mimic more common causes of acute abdominal pain, such as appendicitis, complicating early identification. Computed tomography (CT) is the most useful imaging modality, but even with CT, the diagnosis can be difficult due to the rarity of the condition and the lack of specific signs. Conclusion: Early intervention and surgical correction in this case were crucial to preventing mortality associated with internal hernias. Evidence based medicine ranking: Level IV.