Intestinal Obstruction due to an Intramesosigmoid Hernia

Yuji Akiyama, Kiichi Aoki, Tsutomu Nakaya, Hisataka Fujiwara, Tomohiro Fujita* and Kazuyoshi Saito*

Department of Surgery, Noshiro Yamamoto Kumiai General Hospital
*Department of Surgery I, Iwate Medical University

An internal abdominal hernia through defects in the gastrointestinal mesentery is rare and difficult to correctly diagnose preoperatively. We report a patient with a hernia of the small bowel through a defect of the mesosigmoid. A 39-year-old woman admitted for nausea and vomiting had a history of Caesarean section 14 years earlier. A diagnosis of intestinal obstruction was made and a long tube was placed to decompress the bowel, but to no effect. Surgery was undertaken on day 14 after symptom onset. Incarceration of the small intestine was seen about 100 cm proximal from the terminal ileum into a mesenteric defect on the left side of the mesosigmoid colon. The incarcerated small intestine was reverted and the defect of the sigmoid mesocolon, 2.0 cm in diameter, was closed by suturing. The impacted intestine was not necrotic and the intestine was not resected. Intramesosigmoid hernia is rare. Only 23 cases, including ours, have been reported in Japan. Our case is the first intramesosigmoid hernia, to our knowledge, reported in a woman.

Key words
intramesosigmoid hernia, internal hernia, sigmoid mesocolon

Reprint requests
Yuji Akiyama Department of Surgery, Noshiro Yamamoto Kumiai General Hospital
Kamimaeda, Ochiai, Noshiro, 016-0014 JAPAN

Accepted
April 28, 2004

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