Hamza HASNAOUİ, Ouadii MOUAQİT, Mohamed Lemine BEİLLAHİ, Hicham El BOUHADDOUTİ, El Bachir BENJELLOUN, Abdelmalek OUSADDEN, Khalid Ait TALEB

Konjenital transmesenterik internal herni; Erişkinlerde nadir bir barsak iskemi nedeni: Olgu sunumu

Konjenital transmesenterik fıtıklar, nadir görülen ve yayınlanmış literatürde az sayıda bildirilmiş vaka ile erişkinlerde nadir görülen bir barsak tıkanıklığı ve barsak iskemi nedeni olan çok küçük bir iç fıtık grubunu temsil eder. Hastalığın preoperatif tanısı zordur, erken müdahale ve cerrahi düzeltme, içsel fıtık vakalarına bağlı yüksek morbidite ve mortaliteyi önlemede uzun bir yol kat eder. Daha önce cerrahi öyküsü veya travması olmayan 31 yaşında bir kadın hastada gerçek konjenital transmesenterik herni olgusunu sunuyoruz. Şiddetli karın ağrısı öyküsü ve hem dışkı hem de flatusun kesilmesi ile başvurdu. Abdominal BT taraması tanıyı doğrulayamadı. Hasta abdominal ağrının artması ve şokla ilişkili distansiyon nedeniyle ameliyat edildi. Bir keşif laparotomisi, barsak ilmeklerinin fıtıklandığı ve kangrenli hale gelen doğuştan bir transmesenterik defekti ortaya çıkardı, rezeksiyona ve bir stomi türü Bouilly Volkmann'a neden oldu.

Anahtar Kelimeler:

Konjenital transmesenterik defekt, İnternal fıtık, Bağırsak iskemi

Congenital transmesenteric internal hernia; A rare cause of bowel ischemia in adults: A case report

Congenital transmesenteric hernias represent a very small group of internal hernias which are uncommon and are a rare cause of bowel obstruction and bowel ischemia in adults with few reported cases in published literature. Preoperative diagnosis of the condition is difficult, early intervention and surgical correction goes a long way in preventing high morbidity and mortality associated with cases of internal hernia. We present a case of true congenital transmesenteric hernia in a 31-year-old woman with no previous surgical history or trauma who presented with history of severe abdominal pain and the cessation of both feces and flatus. The abdominal CT scan could not confirm the diagnosis. The patient was operated upon on account of increasing abdominal pain and distention associated with shock. An exploratory laparotomy revealed a congenital transmesenteric defect through which loops of bowel had herniated and become gangrenous, resulting in resection and a stomy type Bouilly Volkmann.

Keywords:

Congenital transmesenteric defect, Internal hernia, Bowel ischemia,

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1. Malit M, Burjonrappa S. Congenital mesenteric defect: description of a rare cause of distal intestinal obstruction in a neonate. International Journal of Surgery and Case Report. 2012;3:121–3.
2. Gyedu A, Damah M, Baidoo PK, Yorke J. Congenital transmesenteric defect caus¬ing bowel strangulation in an adult. Hernia. 2010;14:643–5.
3. Akyildiz H, Artis T, Sozuer E, Akcan A, Kucuk C, Sensoy E, et al. Internal hernia: complex diagnostic and therapeutic problem. International Journal of Surgery. 2009;7:334–7.
4. Martin L, Merkle E, Thompson W. Review of internal hernias: radiographic and clinical findings. American Journal of Roentgenology. 2006;186:703–17.
5. Nouira F, Dhaou BM, Charieg A, Ghorbel S, Jlidi S, Chaouachi B. Small bowel obstruction caused by congenital transmesenteric defect. Afr J Paediatr Surg. 2011;8:75–8.
6. Filip JE, Mattar SG, Bowers SP, Smith CD. Internal hernia formation after laparo¬scopic Roux-en-Y gastric bypass for morbid obesity. Am Surg. 2002;68:640–3.
7. Blachar A, Federle MP, Pealer KM, Ikramuddin S, Schauer PR. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223:625–32.
8. Meyers MA. Dynamic radiology of the abdomen: normal and pathologic anatomy. 4th ed. New York, NY: Springer-Verlag; 1994.
9. Renvall S, Niinikoski J. Internal hernia after gastric operations. Eur J Surg. 1999;157:575–7.
10. Hashimoto D, Hirota M, Sakata K, Yagi Y, Baba H. Adult transmesenteric hernia: report of two cases. Surg Today. 2012;41:489–92.
11. Jung P, Kim MD, Ryu TH, Choi SH, Kim HS, Lee KH, et al. Transmesocolic hernia with strangulation in a patient without surgical history: case report. World J Gastroenterol. 2013;19:1997–9.
12. Gomez R, Rodrigues J. Spontaneous adult transmesenteric hernia with bowel gangrene. Hernia. 2011;15:343–5.
13. Page MP, Ricca RL, Resnick AS, Puder M, Fishman SJ. Newborn and toddler intestinal obstruction owing to con¬genital mesenteric defects. J Pediatr Surg. 2008;43:755–8.
14. Zerrweck C, Sanchez HA, Posada JA, Cervantes J. Giant con¬gential mesenteric hernia in the adult. Act Chir Belg. 2009;109:620–2.