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.

Table 2 Summarize some published cases of adult transverse colon or transversalis fascia hernias

Ref.	Age, sex	Hernia type/site	Diagnosis	Management	Resection	Outcome
Gyedu et al[8], 2010	22, Male	Transmesenteric (jejunal/ileal)	Diagnosed intraoperatively; not established preoperatively	Open laparotomy	Yes	Recovery reported; not detailed further
Butterworth et al[9], 2013	26, Female	Transmesenteric, jejunum and proximal ileum	Not by preoperative CT; diagnosed at exploratory laparoscopy	Laparoscopy converted to open	Yes	Good recovery; discharged day 5
Edwards et al[10], 2013	32, Male	Transmesenteric, transverse colon mesentery	Preoperative CT	Open emergency laparotomy	No	Discharged day 4; no recurrence at 18 months
Jung et al[11], 2013	84, Female	Transmesocolic, beneath transverse colon	Preoperative CT	Emergency surgery (approach not reported)	Yes	Discharged POD11; favorable
Crispín-Trebejo et al[12], 2014	63, Female	Transmesenteric (transverse colon via meso-sigmoid defect, with volvulus)	Preoperative imaging; confirmed at laparoscopy	Laparoscopic derotation and cecopexy	No	Favorable; not further detailed
Beji et al[13], 2022	35, Male	Transmesenteric, distal ileum (congenital 2 cm defect)	Preoperative CT	Open laparotomy	Yes	Recovered uneventfully
Songadkar et al[14], 2024	22, Male	Transmesenteric, distal ileum	Preoperative CT suggestive; confirmed at laparotomy	Open emergency laparotomy + end-ileostomy (later reversed)	Yes	Uneventful after ileostomy reversal
Sinha et al[15], 2025	81, Male	Transmesenteric, ileal (mesenteric band)	Preoperative CT	Surgical exploration; band divided	No	Discharged home; postoperative pneumonia, recovered
Katagiri et al[20], 2013	18, Female	Transmesenteric, jejunal (3 cm defect)	Preoperative CT suggestive; definitive diagnosis intraoperative	Open emergency laparotomy	Yes	Discharged POD6; uneventful
González-Luna et al[21], 2024	35, Female	Transmesenteric, terminal ileum	Diagnostic laparoscopy (preoperative imaging not reported)	Laparoscopy converted to open	Yes	Discharged 72 hours; good at follow-up
Aparício et al[23], 2019 (Case 1)	40, Male	Transmesocolic (descending), sigmoid colon	Preoperative CT and colonoscopy	Open laparotomy (Hartmann)	Yes	Discharged POD6; asymptomatic at 2 years
Aparício et al[23], 2019 (Case 2)	92, Female	Transmesocolic (transverse) and transomental, sigmoid colon	Preoperative CT	Open laparotomy (Hartmann)	Yes	Discharged POD5; asymptomatic at 3 months
Kishiki et al[24], 2015	61, Male	Transmesocolic, transverse colon	Preoperative imaging	Laparoscopic repair	No	Discharged POD6; no recurrence at 1 year
Zhang et al[25], 2023	45, Female	Transmesocolic, transverse mesocolon	Diagnosed intraoperatively at laparoscopy	Emergency laparoscopic exploration	No	Discharged POD6; favorable at 6 months
Present case	62, Female	Transmesocolic, transverse mesocolon	Preoperative CT showed transition point only; hernia diagnosed intraoperatively	Diagnostic laparoscopy; primary closure	No	Discharged POD4; asymptomatic at 2 months

CT: Computed tomography; POD: Postoperative days.