Joshi M, Jha S, Jha S, Jhawar N. Laparoscopic treatment of a transmesocolic internal hernia causing small bowel obstruction: A case report. World J Clin Cases 2026; 14(26): 126834 [DOI: 10.12998/wjcc.126834]
Corresponding Author of This Article
Monika Joshi, Attending Surgeon, Department of Surgery, Apollo Hospitals Navi Mumbai, Navi Mumbai 400614, India. monikamonika105@yahoo.com
Research Domain of This Article
Surgery
Article-Type of This Article
case-report
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Joshi M, Jha S, Jha S, Jhawar N. Laparoscopic treatment of a transmesocolic internal hernia causing small bowel obstruction: A case report. World J Clin Cases 2026; 14(26): 126834 [DOI: 10.12998/wjcc.126834]
Monika Joshi, Saurav Jha, Department of Surgery, Apollo Hospitals Navi Mumbai, Navi Mumbai 400614, India
Smriti Jha, Department of Radiology, Apollo Hospitals Navi Mumbai, Navi Mumbai 400614, India
Nitish Jhawar, Department of General Surgery, Apollo Hospitals Navi Mumbai, Navi Mumbai 400614, India
Co-first authors: Monika Joshi and Saurav Jha.
Co-corresponding authors: Monika Joshi and Nitish Jhawar.
Author contributions: Jhawar N and Joshi M performed the operation, conceptualized the report, and collected the clinical and intraoperative data; Jha S (Smriti Jha) reported on and retrospectively re-reviewed the radiological imaging; Jha S (Saurav Jha), Joshi M, and Jhawar N reviewed and edited the manuscript; and all authors have read and approved the final version; Joshi M and Jhawar N contributed equally to this work.
AI contribution statement: Portions of this manuscript were assisted using Claude (Anthropic), for language refinement. The authors carefully reviewed and verified all AI-assisted outputs, independently confirmed all clinical data and cited literature, and take full responsibility for the scientific content of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors report no conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Monika Joshi, Attending Surgeon, Department of Surgery, Apollo Hospitals Navi Mumbai, Navi Mumbai 400614, India. monikamonika105@yahoo.com
Received: August 14, 2026 Revised: September 7, 2026 Accepted: September 16, 2026 Published online: September 16, 2026 Processing time: 35 Days and 14.8 Hours
Abstract
BACKGROUND
Internal hernia is an uncommon cause of mechanical small bowel obstruction, accounting for 0.5%-5.8% of cases. Reported mortality is > 50% when strangulation occurs and treatment is delayed. The diagnosis is easily overlooked because the clinical presentation is indistinguishable from other mechanical causes of obstruction and preoperative imaging findings are often nonspecific. This paper reports a transmesocolic internal hernia through a defect in the transverse mesocolon, diagnosed and definitively managed laparoscopically.
CASE SUMMARY
A 62-year-old woman presented with 4 days of colicky abdominal pain and repeated vomiting, with obstipation for the preceding 2 days. She had been managed at another hospital for approximately 48 hours with nasogastric decompression, yielding a feculent aspirate. On admission, she was hemodynamically stable, with a soft abdomen and absent bowel sounds. Contrast-enhanced computed tomography showed dilated jejunal loops with an abrupt transition point in a distal jejunal loop, a collapsed distal ileum and colon, and mild free fluid. Bowel wall thickening, abnormal enhancement, or pneumoperitoneum was absent, and internal herniation was not observed. Emergency diagnostic laparoscopy that night demonstrated jejunal loops herniating through a transverse mesocolic defect. The loops were reduced with atraumatic graspers, confirmed viable, and the defect was closed with interrupted 2-0 braided silk sutures. Recovery was uneventful, and she was discharged on the fourth postoperative day. She remained asymptomatic at 2 months, with no recurrence of obstruction and no port-site hernia.
CONCLUSION
Internal herniation should be considered early when mechanical obstruction persists despite decompression and no cause is evident on imaging; laparoscopy provides both diagnosis and definitive repair.
Core Tip: Transmesocolic herniation through a defect in the transverse mesocolon is a rare cause of small bowel obstruction that is easily overlooked before operation. In this patient, contrast-enhanced computed tomography localized an abrupt distal jejunal transition point without signs of ischemia, but the underlying cause was established only during the surgery. Emergency diagnostic laparoscopy on the night of admission allowed the herniated jejunum to be reduced, viability confirmed, and the mesocolic defect closed primarily, avoiding resection. Early exploration and a minimally invasive approach provided diagnosis and definitive treatment in a single procedure.
