Delayed Intestinal Necrosis caused by Traumatic Transmesenteric Hernia

Tetsuya Takahashi, Shun-ichi Osada, Tadao Fukushima, Masao Nanko, Kunio Hashimoto and Toshimichi Takahashi

Department of Surgery, Yokohama Ekisaikai Hospital

A 22-year-old man was admitted to hospital with a diagnosis of intestinal obstruction. He had suffered a blow to the abdomen during a traffic accident about 3 weeks earlier but had not undergone abdominal surgery. Despite conservative treatment, peritoneal irritation developed and an emergency laparotomy was performed the following day, revealing purulent ascites. A defect with a diameter of 3 cm was found in the ileal mesentery about one meter from the end of the ileum. The distal ileum, which had not undergone ischemic damage, protruded through this defect, forming an intestinal obstruction. Necrosis and perforation, which had caused a localized abscess, had developed on the exterior surface of the same loop of the ileum as the mesenteric defect. The affected portion of the ileum was resected, and an end-to-end anastomosis was performed. Mesenteric indurations were scattered elsewhere along the ileum, which was shortened by these lesions. Pathologically, fibrosis and inflammatory cell infiltration were found in the affected mesentery. These results indicated that posttraumatic ischemic damage to the mesentery, which had gradually progressed because of pressure produced by the expansion of the herniated ileum, had caused the necrosis and perforation. The patient recovered fully and was discharged 18 days after the operation.

Key words
blunt abdominal trauma, transmesenteric hernia, necrosis of the intestine

Reprint requests
Tetsuya Takahashi Department of Surgery, Yokohama Ekisaikai Hospital 1-2 Yamada-cho, Naka-ku, Yokohama, 231-0036 JAPAN

Accepted
April 30, 2003

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