Preoperative Suspicion of Internal Hernia and Laparoscopic Repair of a Congenital Transmesocolic Hernia Presenting as Closed-Loop Small-Bowel Obstruction: A Case Report.

INTRODUCTION: Transmesocolic hernia is a rare cause of small-bowel obstruction, and preoperative diagnosis remains difficult because of nonspecific clinical and radiologic findings.

CASE PRESENTATION: A 69-year-old woman presented with abdominal pain and vomiting. Contrast-enhanced CT demonstrated a closed-loop small-bowel obstruction adjacent to the ligament of Treitz, raising suspicion of an internal hernia. Emergency laparoscopic exploration revealed incarceration of a 12-cm segment of jejunum through a transverse mesocolic defect. The bowel was successfully reduced laparoscopically without resection, and the defect was closed using a continuous barbed suture. Direct laparoscopic inspection demonstrated no communication between the defect and the lesser sac, suggesting that the incarcerated bowel remained confined within the transverse mesocolon. The postoperative course was uneventful, and the patient was discharged on POD 8.

CONCLUSIONS: This case highlights the value of early laparoscopic intervention for transmesocolic hernia and provides additional insight into the anatomical variability of transverse transmesocolic hernias.