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

摘要

Konjenital transmesenterik f?t?klar, nadir g?rülen ve yay?nlanm?? literatürde az say?da bildirilmi? vaka ile eri?kinlerde nadir g?rülen bir barsak t?kan?kl??? ve barsak iskemi nedeni olan ?ok kü?ük bir i? f?t?k grubunu temsil eder. Hastal???n preoperatif tan?s? zordur, erken müdahale ve cerrahi düzeltme, i?sel f?t?k vakalar?na ba?l? yüksek morbidite ve mortaliteyi ?nlemede uzun bir yol kat eder. Daha ?nce cerrahi ?yküsü veya travmas? olmayan 31 ya??nda bir kad?n hastada ger?ek konjenital transmesenterik herni olgusunu sunuyoruz. ?iddetli kar?n a?r?s? ?yküsü ve hem d??k? hem de flatusun kesilmesi ile ba?vurdu. Abdominal BT taramas? tan?y? do?rulayamad?. Hasta abdominal a?r?n?n artmas? ve ?okla ili?kili distansiyon nedeniyle ameliyat edildi. Bir ke?if laparotomisi, barsak ilmeklerinin f?t?kland??? ve kangrenli hale gelen do?u?tan bir transmesenterik defekti ortaya ??kard?, rezeksiyona ve bir stomi türü Bouilly Volkmann'a neden oldu. 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.