CASE REPORT Congenital transmesenteric defect causing bowel strangulation in an adult A. Gyedu • M. Damah • P. K. Baidoo • J. Yorke Received: 25 September 2009 / Accepted: 13 November 2009 / Published online: 29 November 2009 Ó Springer-Verlag 2009 Abstract Introduction Congenital transmesenteric hernias repre- sent a very small group of internal hernias which are uncommon and are a rare cause of intestinal obstruction. Diagnosis is frequently made at surgery. Reports of con- genital transmesenteric hernia in the English literature usually involve the pediatric population; adult cases are rarer. Case report A 22-year-old man who presented with a day’s history of severe abdominal pain but without classic physical examination signs of abdominal obstruction was operated upon on account of increasing abdominal pain and distention associated with shock. Laparotomy revealed a congenital transmesenteric defect through which loops of bowel had herniated and become gangrenous, resulting in resection and end-to-end anastomosis. Discussion Congenital transmesenteric defects causing internal hernias in adults are rare. Preoperative diagnosis of the condition is difficult, in part, because there are no radiographic or laboratory findings to confirm the suspi- cion. Misdiagnosis resulting in delayed exploration may lead to small bowel necrosis and subsequent mortality. Conclusion A congenital internal hernia should be con- sidered in a patient with bowel obstruction without previ- ous abdominal surgery, inflammatory abdominal condition, or trauma. We wish to emphasize that, rather than trying to establish a correct diagnosis, the patient’s clinical features should lead to early surgery in order to reduce morbidity and possible mortality. Keywords Congenital Á Transmesenteric Á Defect Á Hernia Á Adult Introduction Congenital transmesenteric hernias represent a very small group of internal hernias which are uncommon and are a rare cause of intestinal obstruction. Although plain abdominal X-ray and computed tomography (CT) findings suggestive of an internal hernia have been described, the diagnosis of transmesenteric hernia is difficult, in part, because there are no radiographic or laboratory findings to confirm the suspicion. Diagnosis is frequently made at surgery. Published reports of congenital transmesenteric hernia in the English literature usually involve the pediatric population; adult cases are rarer. We report the case of a 22-year-old man who presented with a congenital trans- mesenteric hernia, the diagnosis of which was made only at surgery. We stress the need to have a high index of sus- picion with respect to this diagnosis in adults, since early surgery may prevent bowel gangrene. Case presentation A 22-year-old male patient was referred to our hospital with a 1-day history of severe and constant abdominal pain. The abdominal pain was generalized. It was associated with vomiting and anorexia, but without fever, constipa- tion, and diarrhea. He had had no previous similar episodes of abdominal pain and no history of trauma or abdominal A. Gyedu (&) Á M. Damah Á P. K. Baidoo Á J. Yorke Department of Surgery, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana e-mail: drgyedu@gmail.com 123 Hernia (2010) 14:643–645 DOI 10.1007/s10029-009-0600-4