Hernia interna transmesentérica tipo 2: causa infrecuente de obstrucción intestinal

Abstract

Introduction: Internal hernias are defined as an abnormal protrusion of a viscus from an abdominal compartment to another. Transmesenteric internal hernias are rare. Case report: An 87-year-old female patient with colicky pain in the epigastric region of 6 days of evolution, associated with vomiting of intestinal content, mild abdominal distension, cannot pass flatus or stool, past medical history of abdominal surgery 6 years ago, breast cancer operated on 25 years ago, femur fracture 4 years ago, a hip prosthesis carrier. Before in view of clinical deterioration, an exploratory laparoscopy is performed, which reveals a transmesenteric defect at the ileocecal region of approximately 5cm and herniation of 20cm of the distal ileum without signs of necrosis. Devolvulation of the ileal mesentery, content reduction, partial release of the caecum from Toldt's fascia and, laparoscopic orifice repair were performed. Recovery was successful and was discharged three days after admission. Discussion: Clinical symptoms are usually nonspecific for the diagnosis of internal hernias as the clinical diagnosis points to obstruction dues to adhesions consequent to previous surgery or acute appendicitis of the elderly. Likewise, radiological diagnosis has a low sensitivity and specificity in this type of pathology. Laparoscopic surgery for diagnosis and treatment in this pathology is not a first option. Conclusion: Internal hernias can cause potentially lethal intestinal obstruction in the patient. Laparoscopic approach can be performed for diagnosis and treatment of this pathology.