Laparoscopic treatment of a transmesocolic internal hernia causing small bowel obstruction: A case report

Table 1 Clinical timeline

Time point	Clinical event	Key finding or action
Day 1	Onset of symptoms while travelling	Colicky periumbilical pain with progressive nausea and loss of appetite
Days 1-2	Persistent symptoms	Repeated vomiting; no stool or flatus passed from day 2
Day 2	Admission to another hospital	A 16 Fr nasogastric tube placed with feculent aspirate and symptomatic relief; ultrasonography suggestive of small bowel obstruction; decompression continued for approximately 48 hours (until day 4) without resolution; referred onward
Day 4	Presentation to our emergency department	Abdominal pain, vomiting and absolute constipation; hemodynamically stable
Day 4	Contrast-enhanced computed tomography of the abdomen	Abrupt distal jejunal transition zone with a second focal narrowing proximally; proximal jejunum dilated to 3.5-4.0 cm; mild free fluid; no ischemia or perforation
Day 4 (night)	Diagnostic laparoscopy, reduction and laparoscopic mesocolic defect repair	Jejunal loops herniating through a defect in the transverse mesocolon; bowel viable after reduction; defect closed with interrupted 2-0 silk; drain placed
Day 5 (POD 1)	Early postoperative recovery	Bowel sounds sluggish and flatus not passed; mobilized and started on sips of clear fluid
Day 6 (POD 2)	Return of bowel sounds	Nasogastric aspirate fell and tube removed
Day 7 (POD 3)	Return of bowel function	Flatus and stool passed; semi-solid diet tolerated; urinary catheter removed
Day 8 (POD 4)	Drain removal and discharge	Drain removed as output declined; soft diet tolerated; discharged in a hemodynamically stable condition
Day 15	Outpatient review	Reviewed one week after discharge; port site wounds healed; no recurrence of obstructive symptoms
2 months	Follow-up clinic review	Reviewed 2 months after surgery; no recurrence of obstructive symptoms, no port-site hernia; tolerating a normal diet

POD: Postoperative days.