# Traumatic transmesenteric hernia leading to ischemic enterocolitis in an adolescent - case report

## TL;DR

A rare case of traumatic transmesenteric hernia in a teenager caused severe intestinal damage, highlighting the need for early diagnosis and treatment.

## Contribution

This case report adds to the limited literature on traumatic transmesenteric hernias in adolescents and underscores the importance of early surgical intervention.

## Key findings

- A 13-year-old girl with a history of blunt abdominal trauma developed ischemic enterocolitis due to a traumatic transmesenteric hernia.
- Preoperative diagnosis of transmesenteric hernias is difficult, often leading to delayed treatment and severe complications.
- Early surgical intervention is critical to prevent bowel necrosis and mortality in such cases.

## Abstract

Traumatic transmesenteric hernia (TTMH) is an exceptionally rare condition with high morbidity and mortality, particularly in children. It can cause life-threatening complications such as ischemic enterocolitis. Internal hernias, including transmesenteric types, are difficult to diagnose preoperatively and are often discovered during emergency laparotomy.

A 13-year-old girl presented with acute abdominal pain, bilious vomiting, and hypovolemic shock. She had sustained blunt abdominal trauma from a fall two weeks earlier. Initial resuscitation and imaging raised concerns for acute intestinal obstruction. Due to clinical deterioration, an emergency exploratory laparotomy was performed, revealing a transmesenteric hernia with 120 cm of ischemic ileum. Bowel resection and a double-barrel ileostomy were performed. Histopathology confirmed ischemic enterocolitis secondary to the hernia. The patient recovered well and later underwent successful ileostomy reversal.

Transmesenteric hernias are rare, typically congenital or post-surgical, with traumatic cases being extremely uncommon. Diagnosis is challenging due to a lack of specific clinical findings. Delayed intervention increases the risk of bowel ischemia and mortality.

This case highlights the diagnostic difficulty of TTMH and emphasizes the need for a high index of suspicion in trauma patients presenting with acute abdomen. Educating patients with trauma about warning signs & follow up is the recommendation.

•Preoperative diagnosis of transmesenteric hernia is challenging due to the lack of specific clinical or radiological markers.•Early surgical intervention is crucial to prevent bowel ischemia, necrosis, and fatal complications.•This case emphasizes the importance of maintaining a high index of suspicion in trauma patients presenting with acute abdomen.

Preoperative diagnosis of transmesenteric hernia is challenging due to the lack of specific clinical or radiological markers.

Early surgical intervention is crucial to prevent bowel ischemia, necrosis, and fatal complications.

This case emphasizes the importance of maintaining a high index of suspicion in trauma patients presenting with acute abdomen.